Department of Medicine, Section of Cardiology, University of Verona, P. le Stefani 1, 37126 Verona, Italy
Department of Medicine, Section of Cardiology, University of Verona, P. le Stefani 1, 37126 Verona, Italy.
Eur Heart J Cardiovasc Imaging. 2014 Jun;15(6):631-6. doi: 10.1093/ehjci/jet269. Epub 2013 Dec 26.
In patients with aortic stenosis (AS) functional mitral regurgitation (FMR) is frequent and is attributed to left ventricular (LV) remodelling and to aortic gradient. However, the association of these variables with mitral effective regurgitant orifice (ERO) is still unknown.
We prospectively enrolled patients with aortic valve thickness and aortic velocities >2.5 m/s. We measured the LV diastolic (LVD) and systolic volumes (Simpson's method) and ejection fraction (EF) and longitudinal shortening (S-DTI), early, and late (A-DTI) lengthening velocities. The aortic valve area (AVA) and mean gradient (MG) were measured. FMR was considered in the absence of any alteration of mitral leaflet. ERO and regurgitant volume were measured by means of a proximal velocity surface area method method. One hundred and seventy-two patients formed the study population (mean age 76 ± 8 years; 50% female, EF 57 ± 14%, AVA 1.00 ± 0.4 cm(2)). Sixty-three per cent of patients had FMR (ERO range: 0.02 0.32 cm(2)). ERO was significantly associated with LVD (rho = 0.34; P = 0.0001), EF (r(s) = -0.35: P = 0.0001), and S-DTI (r = -0.57; P = 0.0001), A-DTI (rho = -0.47; P = 0.0001). In the subgroup of patients with a preserved EF (LVD <75 mL/m(2) and EF >55%), S-DTI, and A-DTI were the variables with the more powerful association with ERO (r(s) = -0.49 P = 0.0001 and r(s) = -0.40 P = 0.0001, respectively). In the overall population there was a non-significant negative association between the degree of AS and ERO (MG: r(s) = -0.08 P = 0.2 and AVA: r(s) = -0.08 P = 0.2).
In AS patients, the LV function is a main determinant of FMR even if EF is preserved. The association between ERO and valvular gradient is complex but tended to be negative.
在主动脉瓣狭窄（AS）患者中，功能性二尖瓣反流（FMR）很常见，其归因于左心室（LV）重构和主动脉瓣梯度。然而，这些变量与二尖瓣有效反流口（ERO）的相关性仍不清楚。
我们前瞻性地招募了主动脉瓣厚度和主动脉速度>2.5 m/s 的患者。我们测量了 LV 舒张（LVD）和收缩容积（Simpson 法）和射血分数（EF）以及纵向缩短（S-DTI），早期和晚期（A-DTI）伸长速度。测量了主动脉瓣面积（AVA）和平均梯度（MG）。在没有任何二尖瓣瓣叶改变的情况下，考虑存在 FMR。ERO 和反流容积通过近端速度表面积法测量。172 名患者构成了研究人群（平均年龄 76±8 岁；50%为女性，EF 57±14%，AVA 1.00±0.4 cm2）。63%的患者存在 FMR（ERO 范围：0.02-0.32 cm2）。ERO 与 LVD（rho = 0.34；P = 0.0001）、EF（r(s) = -0.35：P = 0.0001）和 S-DTI（r = -0.57；P = 0.0001）显著相关，A-DTI（rho = -0.47；P = 0.0001）。在 EF 保留的患者亚组（LVD <75 mL/m2 和 EF >55%）中，S-DTI 和 A-DTI 与 ERO 的相关性更强（r(s) = -0.49，P = 0.0001 和 r(s) = -0.40，P = 0.0001）。在总体人群中，AS 程度与 ERO 之间存在非显著的负相关（MG：r(s) = -0.08，P = 0.2 和 AVA：r(s) = -0.08，P = 0.2）。
在 AS 患者中，即使 EF 保留，LV 功能也是 FMR 的主要决定因素。ERO 与瓣叶梯度之间的关联很复杂，但倾向于呈负相关。
