Greenberg Cardiology Division, Department of Medicine, Weill Cornell Medical College, New York, New York.
Greenberg Cardiology Division, Department of Medicine, Weill Cornell Medical College, New York, New York; Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
Am J Cardiol. 2014 Aug 1;114(3):355-61. doi: 10.1016/j.amjcard.2014.05.008. Epub 2014 May 16.
Mitral regurgitation (MR) is common with coronary artery disease as altered myocardial substrate can affect valve performance. Single-photon emission computed tomography myocardial perfusion imaging (MPI) enables assessment of myocardial perfusion alterations. This study examined perfusion pattern in relation to MR. A total of 2,377 consecutive patients with known or suspected coronary artery disease underwent stress MPI and echocardiography within 1.6 ± 2.3 days. MR was present on echocardiography in 34% of patients, among whom 13% had advanced (moderate or more) MR. MR prevalence was higher in patients with abnormal MPI (44% vs 29%, p <0.001), corresponding to increased global ischemia (p <0.001). Regional perfusion varied in left ventricular segments adjacent to each papillary muscle: adjacent to the anterolateral papillary muscle, magnitude of baseline and stress-induced anterior/anterolateral perfusion abnormalities was greater in patients with MR (both p <0.001). Adjacent to the posteromedial papillary muscle, baseline inferior/inferolateral perfusion abnormalities were greater with MR (p <0.001), whereas stress inducibility was similar (p = 0.39). In multivariate analysis, stress-induced anterior/anterolateral and rest inferior/inferolateral perfusion abnormalities were independently associated with MR (both p <0.05) even after controlling for perfusion in reference segments not adjacent to the papillary muscles. MR severity increased in relation to magnitude of perfusion abnormalities in each territory adjacent to the papillary muscles, as evidenced by greater prevalence of advanced MR in patients with at least moderate anterior/anterolateral stress perfusion abnormalities (10.7% vs 3.6%), with similar results when MR was stratified based on rest inferior/inferolateral perfusion (10.4% vs 3.0%, both p <0.001). In conclusion, findings demonstrate that myocardial perfusion pattern in left ventricular segments adjacent to the papillary muscles influences presence and severity of MR.
二尖瓣反流（MR）在冠状动脉疾病中很常见，因为心肌底物的改变会影响瓣膜功能。单光子发射计算机断层心肌灌注成像（MPI）可评估心肌灌注改变。本研究探讨了与 MR 相关的灌注模式。共有 2377 例已知或疑似冠状动脉疾病的连续患者在 1.6±2.3 天内行应激 MPI 和超声心动图检查。超声心动图显示 34%的患者存在 MR，其中 13%为重度（中度或更严重）MR。MPI 异常的患者中 MR 的患病率更高（44%比 29%，p<0.001），对应于更高的全局缺血（p<0.001）。与每个乳头肌相邻的左心室节段的局部灌注不同：在前外侧乳头肌相邻处，有 MR 的患者静息和应激诱导的前/前外侧灌注异常的幅度更大（均 p<0.001）。在后内侧乳头肌相邻处，有 MR 的患者静息时下/下外侧灌注异常更大（p<0.001），但应激诱导性相似（p=0.39）。多变量分析显示，应激诱导的前/前外侧和静息下/下外侧灌注异常与 MR 独立相关（均 p<0.05），即使在控制不与乳头肌相邻的参考节段的灌注后也是如此。与乳头肌相邻的每个区域的灌注异常程度相关，MR 严重程度增加，表现为至少有中度前/前外侧应激灌注异常的患者中重度 MR 的患病率更高（10.7%比 3.6%），当根据静息下/下外侧灌注对 MR 进行分层时，结果相似（10.4%比 3.0%，均 p<0.001）。总之，研究结果表明，与乳头肌相邻的左心室节段的心肌灌注模式影响 MR 的存在和严重程度。
