经皮球囊二尖瓣成形术后，自发性左心房声学造影、二尖瓣环收缩期速度及左心耳晚期排空速度对预测左心房功能改善的作用

Spontaneous left atrial echo contrast, mitral annular systolic velocity, and left atrial appendage late emptying velocity in predicting improvement of left atrial function after percutaneous balloon mitral valvuloplasty.

作者信息

Arava Tirumala Naresh, Durgaprasad Rajasekhar, Velam Vanajakshamma, Gajjala Obul Reddy, Neelam Vinod K, Manohar Suchitra N

机构信息

Department of Cardiology, Sri Venkateswara Institute of Medical Sciences, Tirupati, India.

Department of Biochemistry, Sri Venkateswara Institute of Medical Sciences, Tirupati, India.

出版信息

Echocardiography. 2018 Feb;35(2):162-169. doi: 10.1111/echo.13759. Epub 2017 Nov 26.

DOI:10.1111/echo.13759

PMID:29178504

Abstract

BACKGROUND

Thromboembolic events are the major cause of morbidity and mortality in patients with mitral stenosis (MS). This study aims to investigate left atrial spontaneous echo contrast (LA SEC), mitral annular systolic velocity (Sa-wave), left atrial appendage (LAA) late emptying velocity (LAAEV), LAA filling velocity (LAAFV) pre- and postpercutaneous balloon mitral valvuloplasty (PBMV) for MS. This also aims to study the association of LA SEC with inflammatory marker, high-sensitivity C-reactive protein (hs-CRP) in MS.

METHODS

The study population consisted of 100 patients with symptomatic MS with sinus rhythm who underwent PBMV. Transthoracic echo (TTE), tissue Doppler imaging (TDI), and transesophageal echo (TEE) examinations were carried out before and 14 days following PBMV. High-sensitivity C-reactive protein (hs-CRP) was measured at the time of admission.

RESULTS

The mean age was 33.2 ± 10.3 years with female preponderance (71%). There was a decrease in SEC grading, (pre-PBMV 2.8 ± 0.9 and post-PBMV 0.4 ± 0.1; P < .01), increase in LAAEV (pre-PBMV 23.0 ± 7.9 cm/s and post-PBMV 40.9 ± 8.4 cm/s; P < .01), and LAAFV (pre-PBMV 31.8 ± 9.3 cm/s and post-PBMV 51.2 ± 8.7 cm/s; P < .01).A significant positive correlation was present between LAAEV and Sa-wave (r = .52, P < .01). Correlation between hs-CRP and SEC was positive and significant (r = .33, P < .01). Optimal cutoff value of hs-CRP for prediction of moderate to dense SEC was >2.3 mg/dL, the cutoff value of Sa-wave was≤ 5.5 cm/s for prediction of the presence of inactive LAA (LAAEV < 25 cm/s).

CONCLUSION

Mitral annular systolic velocity (Sa-wave) is an independent predictor of inactive LAA and a useful parameter in estimating inactive LAA in MS. Sa-wave and hs-CRP are independent predictors for SEC. PBMV improves LAA function in patients with MS.

摘要

背景

血栓栓塞事件是二尖瓣狭窄（MS）患者发病和死亡的主要原因。本研究旨在调查经皮二尖瓣球囊成形术（PBMV）前后二尖瓣狭窄患者的左心房自发显影（LA SEC）、二尖瓣环收缩期速度（Sa波）、左心耳（LAA）晚期排空速度（LAAEV）、LAA充盈速度（LAAFV）。本研究还旨在探讨MS患者中LA SEC与炎症标志物高敏C反应蛋白（hs-CRP）之间的关联。

方法

研究对象为100例有症状的窦性心律MS患者，均接受了PBMV。在PBMV前及术后14天进行经胸超声心动图（TTE）、组织多普勒成像（TDI）和经食管超声心动图（TEE）检查。入院时检测高敏C反应蛋白（hs-CRP）。

结果

平均年龄为33.2±10.3岁，女性占多数（71%）。SEC分级降低（PBMV前2.8±0.9，PBMV后0.4±0.1；P<.01），LAAEV增加（PBMV前23.0±7.9cm/s，PBMV后40.9±8.4cm/s；P<.01），LAAFV增加（PBMV前31.8±9.3cm/s，PBMV后51.2±8.7cm/s；P<.01）。LAAEV与Sa波之间存在显著正相关（r=.52，P<.01）。hs-CRP与SEC之间的相关性为正且显著（r=.33，P<.01）。预测中度至浓密SEC的hs-CRP最佳截断值>2.3mg/dL，预测无活性LAA（LAAEV<25cm/s）存在的Sa波截断值≤5.5cm/s。