Cameli Matteo, Mandoli Giulia Elena, Nistor Dan, Lisi Edoardo, Massoni Alberto, Crudele Felice, Stricagnoli Mario, Lunghetti Stefano, Mondillo Sergio
Department of Cardiovascular Diseases, University of Siena, Policlinico "Le Scotte", Viale Bracci 1, 53100, Siena, Italy.
Department of Internal Medicine V, University of Medicine and Pharmacy, Targu Mures, Romania.
Int J Cardiovasc Imaging. 2018 Nov;34(11):1741-1751. doi: 10.1007/s10554-018-1391-4. Epub 2018 Jun 9.
In mitral regurgitation (MR), left atrium (LA) and left ventricle (LV) undergo remodeling even if the patient is asymptomatic. The aim of our study was to identify the best echo index that correlates with MR severity in asymptomatic patients affected by MR. We enrolled 150 MR patients (50: mild, 50: moderate, 50: severe), asymptomatic for exertional dyspnea and 50 healthy controls. MR was graded using Doppler quantitative method. All underwent standard and Speckle Tracking Echocardiography (STE) with analysis of global peak atrial longitudinal strain (PALS), LV longitudinal strain (LS) and global atrio-ventricular strain (GAVS). LA dimensions showed significant differences between the groups while LV end-diastolic diameter did not significantly differ, although having a slight increase. PALS was slightly higher in patients with mild MR, while decreased in moderate and, mainly, in severe MR (controls 37.4 ± 12.2%, mild MR 38.2 ± 9%, moderate MR 29.1 ± 9%, severe MR 19.8 ± 10.6%, p < 0.0001 by ANOVA); the same was found for GAVS (56.1 ± 13%, 57.6 ± 9.7%, 48.2 ± 9% 39 ± 9.4%, p < 0.0001 by ANOVA). LV LS showed a tendency for gradual reduction in the three groups. In multivariate analysis, PALS and GAVS were far superior than GLS as predictors of MR groups. PALS emerged as an added value to the LA indexed volumes as predictor of MR severity. STE-derived PALS and GAVS emerged as promising tools to investigate heart longitudinal function in patients with chronic MR and no symptoms. PALS can represent a surplus in the prediction of severity of MR, in addition to the assessment of LA volumes.
在二尖瓣反流（MR）中，即使患者无症状，左心房（LA）和左心室（LV）也会发生重塑。我们研究的目的是确定与无症状MR患者的MR严重程度相关的最佳超声心动图指标。我们纳入了150例MR患者（50例：轻度，50例：中度，50例：重度），这些患者无劳力性呼吸困难症状，以及50名健康对照者。使用多普勒定量方法对MR进行分级。所有人均接受了标准和斑点追踪超声心动图（STE）检查，并分析了整体峰值心房纵向应变（PALS）、左心室纵向应变（LS）和整体房室应变（GAVS）。LA尺寸在各组之间存在显著差异，而左心室舒张末期直径虽有轻微增加，但无显著差异。轻度MR患者的PALS略高，而中度MR患者，尤其是重度MR患者的PALS降低（对照组37.4±12.2%，轻度MR 38.2±9%，中度MR 29.1±9%，重度MR 19.8±10.6%，方差分析p<0.0001）；GAVS情况相同（56.1±13%，57.6±9.7%，48.2±9%，39±9.4%，方差分析p<0.0001）。三组中左心室LS呈逐渐降低趋势。在多变量分析中，PALS和GAVS作为MR分组的预测指标远优于GLS。PALS作为MR严重程度的预测指标，相对于LA指数容积具有附加价值。STE衍生的PALS和GAVS成为研究慢性无症状MR患者心脏纵向功能的有前景的工具。除了评估LA容积外，PALS在预测MR严重程度方面可能具有额外价值。
