Lisi Matteo, Cameli Matteo, Di Tommaso Cristina, Curci Valeria, Reccia Rosanna, D'ascenzi Flavio, Focardi Marta, Maccherini Massimo, Chiavarelli Mario, Lisi Gianfranco, Lindqvist Per, Mondillo Sergio, Henein Michael
Department of Cardiovascular Disease, University of Siena, Siena, Italy.
Department of Public Health and Clinical Medicine, Umeå University and Heart Centre, Umeå, Sweden.
J Clin Ultrasound. 2018 Jan;46(1):32-40. doi: 10.1002/jcu.22521. Epub 2017 Sep 26.
We aimed to assess the relationship between mitral regurgitation (MR) severity, symptoms, and left atrial (LA) structure and function, before and after mitral valve repair (MVR).
Global peak atrial longitudinal strain (PALS) was evaluated in 37 patients with severe symptomatic MR and preserved left ventricular (LV) ejection fraction (60.4% ± 4.6%) before and 3 months after MVR and was compared with values from 30 age- and gender-matched controls.
Before surgery, PALS was worse in patients than in controls and indexed LA volume was greater (P < .0001 for both). After MVR, PALS deteriorated further and LA volume decreased (P = .001 and P = .05, respectively) as did LV ejection fraction, longitudinal strain (P = .05 and P < .001, respectively), and LV mass (P < .0001). Before surgery, LA volume correlated modestly with LV end-diastolic volume (R = 0.51; P = .01); effective regurgitant orifice area (EROA) correlated with PALS (R = -0.69, P < .001) and with LV longitudinal strain (R = 0.54, P = .01), and New York Heart Association class correlated with PALS (R = -0.69, P < .001), EROA (R = 0.69, P < .001), and LA volume (R = 0.51, P = .04). LA volume was the strongest predictor of global PALS reduction (P < .001), whereas global PALS was the main predictor of postoperative atrial fibrillation (AF) (P < .001).
In patients with severe MR, EROA correlate with symptoms and LA PALS, which itself predicts the occurrence of postoperative AF. Strain values were superior to 2D data for the prediction of postoperative AF.
我们旨在评估二尖瓣修复术（MVR）前后二尖瓣反流（MR）严重程度、症状与左心房（LA）结构和功能之间的关系。
对37例重度有症状MR且左心室（LV）射血分数保留（60.4%±4.6%）的患者在MVR前及术后3个月评估整体峰值心房纵向应变（PALS），并与30例年龄和性别匹配的对照组的值进行比较。
术前，患者的PALS比对照组差，且左心房容积指数更大（两者均P<0.0001）。MVR后，PALS进一步恶化，左心房容积减小（分别为P=0.001和P=0.05），LV射血分数、纵向应变（分别为P=0.05和P<0.001）以及LV质量（P<0.0001）也减小。术前，左心房容积与LV舒张末期容积适度相关（R=0.51；P=0.01）；有效反流口面积（EROA）与PALS相关（R=-0.69，P<0.001），与LV纵向应变相关（R=0.54，P=0.01），纽约心脏协会分级与PALS相关（R=-0.69，P<0.001）、与EROA相关（R=0.69，P<0.001）以及与左心房容积相关（R=0.51，P=0.04）。左心房容积是整体PALS降低的最强预测因素（P<0.001），而整体PALS是术后房颤（AF）的主要预测因素（P<0.001）。
在重度MR患者中，EROA与症状和左心房PALS相关，而左心房PALS本身可预测术后AF的发生。应变值在预测术后AF方面优于二维数据。
