Ratanasit Nithima, Karaketklang Khemajira, Krittayaphong Rungroj
Division of Cardiology, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand.
Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand.
BMC Cardiovasc Disord. 2016 Jun 22;16:141. doi: 10.1186/s12872-016-0306-3.
The common pathophysiological consequences of chronic mitral regurgitation (MR) are left atrial (LA) remodeling/dilatation and pulmonary hypertension (PH). We aimed to study the association between LA volume (LAV) and PH in patients with chronic organic MR.
We prospectively studied 154 patients (age 55.0 ± 16.4 years, 39.6 % female) with isolated moderate to severe chronic organic MR. Severity of MR was assessed using proximal isovelocity surface area method. LAV was assessed using the area-length biplane method. PH was defined as pulmonary artery systolic pressure > 50 mmHg.
Ruptured chordae and flail leaflets were the most common etiology of MR (53.2 %). Severe MR (effective regurgitant orifice area (EROA) > 40 mm(2)) was described in 123 (79.9 %) patients. Dyspnea, history of heart failure and atrial fibrillation was reported in 37.7 %, 20.1 % and 29.4 % of patients, respectively. Left ventricular (LV) ejection fraction was 68.1 ± 5.9 %. LAV index and EROA were 67.1 (24.7-391.3) ml/m(2)and 60.3 (10.5-250.9) mm(2), respectively. Age, presence of atrial fibrillation, EROA, LV end-systolic and end-diastolic volume, LV mass index, LAV index and tricuspid annular plane systolic excursion were all factors univariately associated with PH. In multiple logistic regression analysis, age (OR = 1.03, 95 % CI: 1.001-1.06, p = 0.04), EROA (OR = 1.02, 95 % CI: 1.003-1.03, p = 0.017) and LAV index (OR = 1.01, 95 % CI: 1.002-1.02, p = 0.021) were independently associated with PH.
In patients with chronic organic MR, a significant association exists between LAV index and PH. Age, the severity of MR as assessed by EROA, and LAV index are the independent determinants of PH.
慢性二尖瓣反流（MR）常见的病理生理后果是左心房（LA）重塑/扩张和肺动脉高压（PH）。我们旨在研究慢性器质性MR患者的左心房容积（LAV）与PH之间的关联。
我们前瞻性地研究了154例（年龄55.0±16.4岁，女性占39.6%）孤立性中度至重度慢性器质性MR患者。使用近端等速表面积法评估MR的严重程度。使用面积-长度双平面法评估LAV。PH定义为肺动脉收缩压>50 mmHg。
腱索断裂和瓣叶脱垂是MR最常见的病因（53.2%）。123例（79.9%）患者存在严重MR（有效反流口面积（EROA）>40 mm²）。分别有37.7%、20.1%和29.4%的患者报告有呼吸困难、心力衰竭病史和心房颤动。左心室（LV）射血分数为68.1±5.9%。LAV指数和EROA分别为67.1（24.7 - 391.3）ml/m²和60.3（10.5 - 250.9）mm²。年龄、心房颤动的存在、EROA、LV收缩末期和舒张末期容积、LV质量指数、LAV指数和三尖瓣环平面收缩期位移均为单因素分析中与PH相关的因素。在多因素逻辑回归分析中，年龄（OR = 1.03，95%CI：1.001 - 1.06，p = 0.04）、EROA（OR = 1.02，95%CI：1.003 - 1.03，p = 0.017）和LAV指数（OR = 1.01，95%CI：1.002 - 1.02，p = 0.021）与PH独立相关。
在慢性器质性MR患者中，LAV指数与PH之间存在显著关联。年龄、通过EROA评估的MR严重程度和LAV指数是PH的独立决定因素。
