Poyraz Esra, Öz Tuğba Kemaloğlu, Zeren Gönül, Güvenç Tolga Sinan, Dönmez Cevdet, Can Fatma, Güvenç Rengin Çetin, Dayı Şennur Ünal
Department of Cardiology, Dr. Siyami Ersek Cardiovascular and Thoracic Surgery Research and Training Hospital, Tıbbiye Street No:13, Kadıköy, Istanbul, Turkey.
Int J Cardiovasc Imaging. 2017 Sep;33(9):1323-1330. doi: 10.1007/s10554-017-1109-z. Epub 2017 Mar 11.
In a fraction of patients with mild mitral stenosis, left ventricular systolic function deteriorates despite the lack of hemodynamic load imposed by the dysfunctioning valve. Neither the predisposing factors nor the earlier changes in left ventricular contractility were understood adequately. In the present study we aimed to evaluate left ventricular mechanics using three-dimensional (3D) speckle tracking echocardiography. A total of 31 patients with mild rheumatic mitral stenosis and 27 healthy controls were enrolled to the study. All subjects included to the study underwent echocardiographic examination to collect data for two- and three-dimensional speckle-tracking based stain, twist angle and torsion measurements. Data was analyzed offline with a echocardiographic data analysis software. Patients with rheumatic mild MS had lower global longitudinal (p < 0.001) circumferential (p = 0.02) and radial (p < 0.01) strain compared to controls, despite ejection fraction was similar for both groups [(p = 0.45) for three dimensional and (p = 0.37) for two dimensional measurement]. While the twist angle was not significantly different between groups (p = 0.11), left ventricular torsion was significantly higher in mitral stenosis group (p = 0.03). All strain values had a weak but significant positive correlation with mitral valve area measured with planimetry. Subclinical left ventricular systolic dysfunction develops at an early stage in rheumatic mitral stenosis. Further work is needed to elucidate patients at risk for developing overt systolic dysfunction.
在一部分轻度二尖瓣狭窄患者中，尽管功能失调的瓣膜未施加血流动力学负荷，但左心室收缩功能仍会恶化。对于其诱发因素以及左心室收缩力的早期变化，人们尚未充分了解。在本研究中，我们旨在使用三维（3D）斑点追踪超声心动图评估左心室力学。共有31例轻度风湿性二尖瓣狭窄患者和27名健康对照者纳入本研究。纳入研究的所有受试者均接受超声心动图检查，以收集基于二维和三维斑点追踪的应变、扭转角和扭转测量数据。使用超声心动图数据分析软件对数据进行离线分析。与对照组相比，风湿性轻度二尖瓣狭窄患者的整体纵向应变（p < 0.001）、圆周应变（p = 0.02）和径向应变（p < 0.01）较低，尽管两组的射血分数相似[三维测量时（p = 0.45），二维测量时（p = 0.37）]。虽然两组之间的扭转角无显著差异（p = 0.11），但二尖瓣狭窄组的左心室扭转明显更高（p = 0.03）。所有应变值与用平面测量法测得的二尖瓣面积均呈弱但显著的正相关。风湿性二尖瓣狭窄早期会出现亚临床左心室收缩功能障碍。需要进一步开展工作以阐明有发生明显收缩功能障碍风险的患者。
