Department of Clinical Laboratory, Graduate School of Medicine, The University of Tokyo.
Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo.
Int Heart J. 2021 May 29;62(3):552-558. doi: 10.1536/ihj.20-776. Epub 2021 May 15.
Preservation of the mitral valve (MV) size is essential for valve function, and a reduced MV coaptation-zone area increases the risk of developing functional mitral regurgitation (FMR). We aimed to determine if the MV leaflet and coaptation-zone areas were associated with the severity of atherosclerosis assessed by cardio-ankle vascular index (CAVI) in patients with normal left ventricle (LV) systolic function and size by real-time 3D echocardiography (RT3DE).We performed RT3DE analysis in 66 patients with normal LV size and ejection fraction who underwent 2D echocardiography and CAVI. MV coaptation-zone areas were measured by custom 3D software and indexed by body surface area (BSA). The associations of clinical factors and mean CAVI with MV leaflet and coaptation-zone areas were evaluated by univariable and multivariable linear regression analyses.On univariable analysis, MV leaflet area/BSA was significantly associated with age (r = -0.335, P = 0.0069) and mean CAVI (r = -0.464, P < 0.001), and MV coaptation-zone area was significantly associated with age (r = -0.626, P < 0.001), hypertension (r = -0.626, P < 0.001), dyslipidemia (r = -0.626, P < 0.001), E/e' (r = -0.626, P < 0.001), and CAVI (r = -0.740, P < 0.001). On multivariable analysis, mean CAVI was independently associated only with MV leaflet area/BSA (standardized coefficient = -0.611, P < 0.001) and MV coaptation-zone area/BSA (standardized coefficient = -0.74, P < 0.001).In patients with normal LV systolic function and size, MV leaflet and coaptation-zone areas might be reduced according to advancing atherosclerosis. Patients with atherosclerosis might be at increased risk of developing FMR.
保留二尖瓣 (MV) 大小对于瓣膜功能至关重要，而 MV 交界区面积减小会增加发生功能性二尖瓣反流 (FMR) 的风险。我们旨在通过实时三维超声心动图 (RT3DE) 确定 MV 瓣叶和交界区面积是否与通过二维超声心动图和心血管踝臂指数 (CAVI) 评估的正常左心室 (LV) 收缩功能和大小患者的动脉粥样硬化严重程度相关。我们对 66 例 LV 大小和射血分数正常的患者进行了 RT3DE 分析，这些患者接受了二维超声心动图和 CAVI 检查。使用定制的 3D 软件测量 MV 交界区面积，并按体表面积 (BSA) 进行指数化。通过单变量和多变量线性回归分析评估临床因素和平均 CAVI 与 MV 瓣叶和交界区面积的关系。在单变量分析中，MV 瓣叶面积/BSA 与年龄 (r = -0.335，P = 0.0069) 和平均 CAVI (r = -0.464，P < 0.001) 显著相关，而 MV 交界区面积与年龄 (r = -0.626，P < 0.001)、高血压 (r = -0.626，P < 0.001)、血脂异常 (r = -0.626，P < 0.001)、E/e' (r = -0.626，P < 0.001) 和 CAVI (r = -0.740，P < 0.001) 显著相关。在多变量分析中，仅平均 CAVI 与 MV 瓣叶面积/BSA (标准化系数 = -0.611，P < 0.001) 和 MV 交界区面积/BSA (标准化系数 = -0.74，P < 0.001) 独立相关。在 LV 收缩功能和大小正常的患者中，MV 瓣叶和交界区面积可能会随着动脉粥样硬化的进展而减小。患有动脉粥样硬化的患者可能有更高的发生 FMR 的风险。
