Morbach Caroline, Bellavia Diego, Störk Stefan, Sugeng Lissa
Yale School of Medicine, Section Cardiovascular Medicine, 330 Cedar Street, P.O Box 208017, New Haven, CT, 06511, USA.
Comprehensive Heart Failure Center and Department of Internal Medicine I, University of Würzburg, Würzburg, Germany.
BMC Cardiovasc Disord. 2018 May 10;18(1):93. doi: 10.1186/s12872-018-0819-z.
Mitral regurgitation in ischemic heart disease (IMR) is a strong predictor of outcome but until now, pathophysiology is not sufficiently understood and treatment is not satisfying. We aimed to systematically evaluate structural and functional mitral valve leaflet and annular characteristics in patients with IMR to determine the differences in geometric and dynamic changes of the MV between significant and mild IMR.
Thirty-seven patients with IMR (18 mild (m)MR, 19 significant (moderate+severe) (s)MR) and 33 controls underwent TEE. 3D volumes were analyzed using 3D feature-tracking software.
All IMR patients showed a loss of mitral annular motility and non-planarity, whereas mitral annulus dilation and leaflet enlargement occurred in sMR only. Active-posterior-leaflet-area decreased in early systole in all three groups accompanied by an increase in active-anterior-leaflet-area in early systole in controls and mMR but only in late systole in sMR.
In addition to a significant enlargement and loss in motility of the MV annulus, patients with significant IMR showed a spatio-temporal alteration of the mitral valve coaptation line due to a delayed increase in active-anterior-leaflet-area. This abnormality is likely to contribute to IMR severity and is worth the evaluation of becoming a parameter for clinical decision-making. Further, addressing the leaflets aiming to increase the active leaflet-area is a promising therapeutic approach for significant IMR. Additional studies with a larger sample size and post-operative assessment are warranted to further validate our findings and help understand the dynamics of the mitral valve.
缺血性心脏病中的二尖瓣反流（IMR）是预后的有力预测指标，但迄今为止，其病理生理学尚未得到充分理解，治疗效果也不尽人意。我们旨在系统评估IMR患者二尖瓣叶和瓣环的结构及功能特征，以确定重度和轻度IMR患者二尖瓣（MV）几何形状和动态变化的差异。
37例IMR患者（18例轻度（m）MR，19例重度（中度+重度）（s）MR）和33例对照者接受了经食管超声心动图（TEE）检查。使用三维特征跟踪软件分析三维容积。
所有IMR患者均表现出二尖瓣环运动丧失和非平面化，而二尖瓣环扩张和瓣叶增大仅发生在重度MR患者中。三组患者在收缩早期活动后叶面积均减小，对照组和轻度MR患者在收缩早期活动前叶面积增加，而重度MR患者仅在收缩晚期增加。
除了二尖瓣环显著增大和运动丧失外，重度IMR患者由于活动前叶面积延迟增加，二尖瓣瓣叶贴合线出现时空改变。这种异常可能导致IMR严重程度增加，值得评估其是否可成为临床决策参数。此外，针对瓣叶增加活动瓣叶面积是重度IMR一种有前景的治疗方法。需要进行更多样本量的研究及术后评估，以进一步验证我们的发现，并帮助理解二尖瓣的动力学。
