Sanfilippo A J, Abdollah H, Burggraf G W
Division of Cardiology, Queen's University, Hotel Dieu Hospital, Kingston, Ontario, Canada.
Am J Cardiol. 1989 Dec 1;64(19):1349-55. doi: 10.1016/0002-9149(89)90580-8.
Superior systolic displacement of the mitral leaflets is the echocardiographic finding generally used to diagnose mitral valve prolapse, but its clinical significance is not clearly established. This study was designed to determine if the presence of leaflet thickening, displacement in the multiple imaging planes or the quantitative degree of displacement could be used to identify clinically important valvular abnormality. To this end, these findings were prospectively assessed and correlated with the presence of mitral regurgitation and ventricular arrhythmia in 49 patients with displacement and in 49 age-matched control subjects with no identifiable displacement. Both ventricular arrhythmia and mitral regurgitation were found to occur with significantly greater frequency in patients with leaflet displacement than in control subjects. However, among the patients with leaflet displacement, both these complications occurred with greater frequency in subgroups characterized by the presence of leaflet thickening, quantitatively greater displacement and displacement evident in 2 orthogonal imaging planes. Logistic regression analysis demonstrated that the best echocardiographic predictor of either ventricular arrhythmia or mitral regurgitation was the quantitative degree of leaflet displacement. These results indicate that most patients with echocardiographic evidence of leaflet displacement had very low incidences of ventricular arrhythmia and mitral regurgitation. Subgroups, however, could be identified echocardiographically in which both complications occurred with significantly greater frequency.
二尖瓣叶收缩期上移是超声心动图用于诊断二尖瓣脱垂的常见表现，但其临床意义尚未明确。本研究旨在确定瓣叶增厚、多平面移位或移位的定量程度是否可用于识别具有临床意义的瓣膜异常。为此，对49例有移位的患者和49例年龄匹配、无明显移位的对照者进行前瞻性评估，分析上述表现与二尖瓣反流及室性心律失常的关系。结果发现，瓣叶移位患者的室性心律失常和二尖瓣反流发生率显著高于对照组。然而，在瓣叶移位患者中，瓣叶增厚、移位定量程度更高以及在两个正交平面上均有明显移位的亚组，这两种并发症的发生率更高。逻辑回归分析表明，瓣叶移位的定量程度是室性心律失常或二尖瓣反流的最佳超声心动图预测指标。这些结果表明，大多数有瓣叶移位超声心动图证据的患者发生室性心律失常和二尖瓣反流的几率很低。然而，通过超声心动图可以识别出这两种并发症发生率显著更高的亚组。
