Department of Cardiology, University of Health Sciences, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Training and Research Hospital; İstanbul-Turkey.
Department of Cardiology, Dumlupınar University, Kütahya Evliya Çelebi Training and Research Hospital; Kütahya-Turkey.
Anatol J Cardiol. 2020 Oct;24(4):254-259. doi: 10.14744/AnatolJCardiol.2020.03835.
This prospective study aimed to investigate the myocardial energy metabolism in severe mitral regurgitation (MR) and explore its effect on postoperative differentiation of ejection fraction (EF).
A total of 85 patients with severe MR were prospectively enrolled from October 2018 to June 2019. During the study period, a total of 50 patients underwent mitral valve surgery and 49 patients were finally enrolled due to 1 missing data. Left ventricular function, circumferential end-systolic stress (cESS), and myocardial energy expenditure (MEE) were measured by transthoracic echocardiography preoperatively and 3 months after surgery. Patients were divided into 2 groups according to absolute difference of postoperative differentiation of EF.
Nine patients underwent mitral valve repair and 40 underwent prosthetic valve replacement. Patients with reduced EF had higher MEE demonstrated with cESS and MEE. Negative correlation between preoperative EF and N-terminal pro-brain natriuretic peptide (NT-proBNP), cESS, MEEs, and MEEm and positive correlation between preoperative EF and effective regurgitant orifice area were found. Complications occurred in 12 patients during hospitalization. Basal NT-proBNP, left atrium (LA), and cESS were significantly higher in postoperatively decreased EF group. Taking into consideration the covariates of multiple logistic regression analysis, LA and cESS were found to be independent predictors of EF reduction postoperatively.
Higher LA and cESS are independent predictors of postoperative EF reduction. Preoperative high end-systolic stress could predict postoperative EF reduction and hence could be helpful for determining the timing of mitral valve surgery. Although MEE was higher in postoperatively decreased EF group, it did not reach statistical significance.
本前瞻性研究旨在探讨严重二尖瓣反流（MR）患者的心肌能量代谢情况及其对射血分数（EF）术后差异的影响。
2018 年 10 月至 2019 年 6 月，前瞻性纳入 85 例严重 MR 患者，其中 50 例行二尖瓣手术，1 例失访，最终纳入 49 例。术前及术后 3 个月行经胸超声心动图测量左心室功能、圆周收缩末期压力（cESS）和心肌能量消耗（MEE）。根据术后 EF 绝对差值将患者分为 EF 降低组和 EF 不变组。
9 例行二尖瓣修复术，40 例行人工瓣膜置换术。EF 降低组患者的 MEE 更高，表现为 cESS 和 MEE 更高。术前 EF 与 N 末端脑钠肽前体（NT-proBNP）、cESS、MEEs 和 MEEm 呈负相关，与有效反流口面积呈正相关。住院期间 12 例患者发生并发症。术后 EF 降低组患者的基础 NT-proBNP、左心房（LA）和 cESS 明显更高。多因素逻辑回归分析考虑协变量后，LA 和 cESS 是术后 EF 降低的独立预测因子。
较高的 LA 和 cESS 是术后 EF 降低的独立预测因子。术前高收缩末期压力可预测术后 EF 降低，有助于确定二尖瓣手术时机。虽然术后 EF 降低组的 MEE 较高，但无统计学意义。
