Santoro Ciro, Galderisi Maurizio, Esposito Roberta, Buonauro Agostino, Monteagudo Juan Manuel, Sorrentino Regina, Lembo Maria, Fernandez-Golfin Covadonga, Trimarco Bruno, Zamorano Josè Luis
Department of Advanced Biomedical Science, Interdepartmental Laboratory of Cardiac Imaging, Federico II University Hospital, V. S. Pansini 5, bld 1, 80131, Naples, Italy.
Department of Cardiology, University Hospital Ramon y Cajal, Madrid, Spain.
Cardiovasc Ultrasound. 2019 Nov 21;17(1):28. doi: 10.1186/s12947-019-0178-7.
The search for reliable cardiac functional parameters is crucial in patients with mitral regurgitation (MR). In the Italian arm of the European Registry of MR, we compared the ability of global longitudinal strain (GLS) and left ventricular (LV) ejection fraction (LVEF) to detect cardiac damage in MR.
Five hundred four consecutive patients with MR underwent a complete echo-Doppler exam. A total of 431, 53 and 20 patients had degenerative, secondary and mixed MR, respectively. The main echocardiographic parameters, including LV and left atrial (LA) size measurements, pulmonary artery systolic pressure (PASP) and GLS were compared between patients with mild MR (n = 392) vs. moderate to severe MR (n = 112).
LVEF and GLS were related one another in the pooled population, and separately in patients with mild and moderate/severe MR (all p < 0.0001). However, a certain number of patients were above the upper or below the lower limits of the 95% confidence interval (CI) of the normal relation in the pooled population and in patients with mild MR. Only 2 patients were below the 95% CI in moderate to severe MR. After adjusting for confounders by separate multivariate models, LVEF and GLS were independently associated with LV and left atrial size in the pooled population and in mild and moderate/severe MR. GLS, but not LVEF, was also independently associated with PASP in patients with mild and moderate to severe MR.
Both LVEF and GLS are independently associated with LV and LA size, but only GLS is related to pulmonary arterial pressure. GLS is a powerful hallmark of cardiac damage in MR.
对于二尖瓣反流（MR）患者而言，寻找可靠的心脏功能参数至关重要。在欧洲MR注册研究的意大利分支中，我们比较了整体纵向应变（GLS）和左心室（LV）射血分数（LVEF）检测MR患者心脏损伤的能力。
连续504例MR患者接受了完整的超声多普勒检查。分别有431例、53例和20例患者患有退行性、继发性和混合性MR。比较了轻度MR患者（n = 392）与中重度MR患者（n = 112）之间的主要超声心动图参数，包括左心室和左心房（LA）大小测量值、肺动脉收缩压（PASP）和GLS。
在总体人群中，以及在轻度和中重度MR患者中，LVEF和GLS均相互关联（所有p < 0.0001）。然而，在总体人群和轻度MR患者中，有一定数量的患者高于正常关系95%置信区间（CI）的上限或低于下限。在中重度MR中，只有2例患者低于95%CI。通过单独的多变量模型对混杂因素进行调整后，在总体人群以及轻度和中重度MR中，LVEF和GLS均与左心室和左心房大小独立相关。在轻度和中重度MR患者中，GLS而非LVEF也与PASP独立相关。
LVEF和GLS均与左心室和左心房大小独立相关，但只有GLS与肺动脉压相关。GLS是MR患者心脏损伤的有力标志。
