Department of Cardiology, GIPMER, MAMC, New Delhi, 110002, India.
Department of Cardiology, GIPMER, MAMC, New Delhi, 110002, India.
Indian Heart J. 2020 Jul-Aug;72(4):252-257. doi: 10.1016/j.ihj.2020.07.001. Epub 2020 Jul 10.
Patients undergoing successful balloon mitral valvuloplasty (BMV) have variable improvement in New York Heart Association (NYHA) functional class (FC), exercise capacity (EC) and regression of systolic pulmonary artery pressure (sPAP). Improvement in net atrioventricular compliance (Cn), one of the major determinants of above factors is not routinely assessed. Aim of present study was to assess the change in Cn after successful BMV and its correlation with above factors.
50 patients of very severe mitral stenosis in sinus rhythm who underwent successful BMV have been studied. NYHA FC, 6 min walk test (6 MWT) and echocardiographic evaluation was done 24 h before and at 2 weeks, 12 weeks and 24 weeks after BMV. Echocardiographic parameters of patients with improvement in NYHA class of ≥2 (group A) were also compared with those with improvement in NYHA class of ≤1 (group B).
Following successful BMV, there was progressive improvement in Cn upto 12 weeks with no further significant improvement till 24 weeks. Change in Cn showed very good correlation with change in NYHA class [r = 0.62, p < 0.01], 6 MWT [r = 0.30, p0.03] and regression of sPAP assessed at 12 weeks and was maintained upto 24 weeks. Change in MVA did not show any correlation with above factors. Group B patients had significantly lower Cn post BMV as compared to group A patients inspite of comparable MVA and trans valvular gradients.
Improvement in Cn following BMV has good correlation with clinical improvement. So Cn should also be assessed along with MVA to better predict clinical outcome.
成功进行球囊二尖瓣成形术（BMV）的患者，纽约心脏协会（NYHA）功能分级（FC）、运动能力（EC）和收缩期肺动脉压（sPAP）均有不同程度的改善。但作为上述因素的主要决定因素之一的净房室顺应性（Cn）的改善并未得到常规评估。本研究旨在评估成功进行 BMV 后 Cn 的变化及其与上述因素的相关性。
研究纳入了 50 例窦性心律下严重二尖瓣狭窄且成功进行 BMV 的患者。在 BMV 前 24 小时、2 周、12 周和 24 周时，对患者进行 NYHA FC、6 分钟步行试验（6MWT）和超声心动图评估。还比较了 NYHA 分级改善≥2 级（A 组）和改善≤1 级（B 组）的患者的超声心动图参数。
成功进行 BMV 后，Cn 逐渐改善，直至 12 周，24 周时无进一步显著改善。Cn 的变化与 NYHA 分级的变化呈很好的相关性（r=0.62，p<0.01）、6MWT 的变化（r=0.30，p<0.03）和 12 周时 sPAP 的回归，且这种相关性一直维持到 24 周。而 MVA 的变化与上述因素均无相关性。尽管 BMV 后两组的 MVA 和跨瓣压差相当，但 B 组患者的 Cn 值明显低于 A 组。
BMV 后 Cn 的改善与临床改善有很好的相关性。因此，除了 MVA 外，还应该评估 Cn，以更好地预测临床结局。
