Choi Jah Yeon, Suh Young Joo, Seo Jiwon, Choi Kang-Un, Hong Geu-Ru, Lee Sak, Lee Seung-Hyun, Ha Jong-Won, Kim Young Jin, Shim Chi Young
Cardiovascular Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul 08308, Korea.
Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea.
J Clin Med. 2021 Jan 10;10(2):222. doi: 10.3390/jcm10020222.
Clinical presentation of patients with mitral paravalvular leakage (PVL) varies from asymptomatic to heart failure related with hemolytic anemia or pulmonary hypertension. We aimed to investigate the structural and functional characteristics of mitral PVL by multimodal imaging and their association with the severity of hemolysis and hemodynamic significance.
A total of 74 patients with mitral PVL who underwent both cardiac computed tomography (CT) and echocardiography from March 2010 to December 2017 was investigated. Location and size of PVL, degree of left atrial (LA) calcification as measured by CT, and hemodynamic variables as measured by echocardiography were comprehensively analyzed. To investigate the degree of hemolysis and pulmonary hypertension, level of lactate dehydrogenase (LDH) and Doppler estimated systolic pulmonary artery pressure (SPAP) were used respectively.
Level of LDH was not related to PVL perimeter and was variable, especially in patients with a small PVL. However, it was positively correlated with mean mitral regurgitation velocity. Additionally, SPAP was significantly correlated with PVL perimeter and LA calcium score. In multivariable analysis, mean mitral regurgitation velocity was significantly correlated with levels of LDH (β = 0.345; = 0.016), and PVL perimeter and LA calcium score were independently associated with SPAP (β = 0.249; = 0.036 and β = 0.467; < 0.001, respectively).
Characteristics of mitral PVL and adjacent structures are associated with the severity of hemolysis and pulmonary hypertension. Evaluating the structural and functional characteristics of mitral PVL by complementary multimodal imaging would be important for understanding the clinical presentation and deciding optimal treatments for individual patients.
二尖瓣瓣周漏（PVL）患者的临床表现从无症状到与溶血性贫血或肺动脉高压相关的心力衰竭不等。我们旨在通过多模态成像研究二尖瓣PVL的结构和功能特征及其与溶血严重程度和血流动力学意义的关联。
对2010年3月至2017年12月期间接受心脏计算机断层扫描（CT）和超声心动图检查的74例二尖瓣PVL患者进行了研究。综合分析了PVL的位置和大小、CT测量的左心房（LA）钙化程度以及超声心动图测量的血流动力学变量。为了研究溶血程度和肺动脉高压，分别使用了乳酸脱氢酶（LDH）水平和多普勒估计的收缩期肺动脉压（SPAP）。
LDH水平与PVL周长无关且变化较大，尤其是在PVL较小的患者中。然而，它与二尖瓣反流平均速度呈正相关。此外，SPAP与PVL周长和LA钙评分显著相关。在多变量分析中，二尖瓣反流平均速度与LDH水平显著相关（β = 0.345；P = 0.016），PVL周长和LA钙评分分别与SPAP独立相关（β = 0.249；P = 0.036和β = 0.467；P < 0.001）。
二尖瓣PVL及其相邻结构的特征与溶血和肺动脉高压的严重程度相关。通过互补的多模态成像评估二尖瓣PVL的结构和功能特征对于理解临床表现以及为个体患者确定最佳治疗方案具有重要意义。
