Çakıcı Musa, Doğan Adnan, Çetin Mustafa, Süner Arif, Polat Mustafa, Oylumlu Muhammed, Aktürk Erdal, Abus Sabri, Üçkardeş Fatih
Department of Cardiology, Faculty of Medicine, Adıyaman University; Adıyaman-Turkey.
Anatol J Cardiol. 2015 Jul;15(7):542-7. doi: 10.5152/akd.2014.5562. Epub 2014 Jun 23.
The coronary sinus (CS) has been largely ignored by physicians due to a lack of adequate data about the importance of CS enlargement in patients with heart failure (HF). We aimed to assess whether CS dilatation develops in patients with HF and to demonstrate its relation with global myocardial function of the right ventricle (RV).
In this cross-sectional study, 45 healthy subjects and 95 HF patients exhibiting left ventricular systolic dysfunction on echocardiographic examination (EF <45%) secondary to ischemic (n=56) or idiopathic dilated cardiomyopathy (DCM) (n=39) were enrolled. Patients with severe renal dysfunction and/or valve disease were excluded. CS was measured by echocardiography from the posterior atrioventricular groove in the apical four-chamber view. The RV myocardial performance index (MPI), which reflects both systolic and diastolic function of the ventricle, was detected using tissue Doppler imaging, and patients with an RV MPI >0.55 were defined as having impaired RV myocardial function. ANOVA, Kruskal-Wallis, Pearson's correlation, and multivariate logistic regression analyses were used for the statistical analysis.
The CS and RV MPI values were significantly greater both in patients with ischemic and idiopathic DCM than in controls (8.79±1.7 mm and 8.33±2.1 mm vs. 5.74±0.6 mm, and 0.64±0.07 and 0.62±0.08 vs. 0.43±0.02; p<0.001 for both, respectively). For the prediction of HF patients with impaired RV function, the cut-off value for the diameter of the CS was 7.35 mm, with a sensitivity of 83% and a specificity of 79%.
The CS diameter can be used as a novel echocardiographic marker that provides information about impaired RV function in patients with HF.
由于缺乏关于心力衰竭（HF）患者冠状窦（CS）扩大重要性的充分数据，医生很大程度上忽视了冠状窦。我们旨在评估HF患者是否会出现CS扩张，并证明其与右心室（RV）整体心肌功能的关系。
在这项横断面研究中，纳入了45名健康受试者和95名经超声心动图检查显示左心室收缩功能障碍（射血分数<45%）的HF患者，其中缺血性心肌病（n = 56）或特发性扩张型心肌病（DCM）（n = 39）。排除严重肾功能不全和/或瓣膜病患者。通过超声心动图在心尖四腔视图中从房室后沟测量CS。使用组织多普勒成像检测反映心室收缩和舒张功能的RV心肌性能指数（MPI），RV MPI>0.55的患者被定义为RV心肌功能受损。采用方差分析、Kruskal-Wallis检验、Pearson相关性分析和多因素逻辑回归分析进行统计分析。
缺血性和特发性DCM患者的CS和RV MPI值均显著高于对照组（分别为8.79±1.7 mm和8.33±2.1 mm对5.74±0.6 mm，以及0.64±0.07和0.62±0.08对0.43±0.02；两者p均<0.001）。对于预测RV功能受损的HF患者，CS直径的截断值为7.35 mm，敏感性为83%，特异性为79%。
CS直径可作为一种新的超声心动图标志物，为HF患者RV功能受损提供信息。
