Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
Eur Heart J Cardiovasc Imaging. 2021 Aug 14;22(9):964-973. doi: 10.1093/ehjci/jeab098.
This study aimed to evaluate the prevalence and distribution of pulmonary venous systolic flow reversal (PVSFR) in patients with severe mitral regurgitation (MR), and to examine the relationship between PVSFR profile and cardiac parameters.
A total of 125 patients with severe MR who had transoesophageal echocardiography (TOE) performed were reviewed. Of these, 121 (96.8%) patients showed all four pulmonary venous (PV) flows by TOE. They were categorized into three groups by the MR aetiology: degenerative MR (DMR) (n = 72), ventricular functional MR (V-FMR) (n = 20), and atrial functional MR (A-FMR) (n = 16). Eighteen (16.7%) patients had PVSFR in all four PVs. Twenty-nine (26.9%) had PVSFR in three PVs, 23 (21.3%) in two PVs, and 23 (21.3%) in one PV. PVSFR appeared at right PVs more frequently compared with left PVs. A high number of PVSFR was significantly correlated with higher pulmonary capillary wedge pressure (PCWP) and 3D vena contracta area (3D-VCA). With regard to MR aetiology, the number of PVSFRs was correlated with high 3D-VCA in patients with DMR and A-FMR, while it was correlated with high PCWP in patients with V-FMR. Laminar-type PVSFR appeared more frequently in FMR compared with DMR, and it had a relationship with higher PCWP and lower right ventricular fractional area change (RVFAC).
All four PV were detected in 96.8%, and 16.8% patients had PVSFR in all four PVs. PCWP and 3D-VCA were correlated with the number of PVSFRs in severe MR patients. Laminar-type PVSFR was related to higher PCWP and lower RVFAC.
本研究旨在评估重度二尖瓣反流（MR）患者肺静脉收缩期血流反流（PVSFR）的发生率和分布，并探讨 PVSFR 形态与心脏参数之间的关系。
回顾了 125 例接受经食管超声心动图（TOE）检查的重度 MR 患者。其中，121 例（96.8%）患者通过 TOE 显示了所有四个肺静脉（PV）的血流。根据 MR 病因将他们分为三组：退行性 MR（DMR）（n=72）、心室功能性 MR（V-FMR）（n=20）和心房功能性 MR（A-FMR）（n=16）。18 例（16.7%）患者在所有四个 PV 中均出现 PVSFR。29 例（26.9%）患者在三个 PV 中出现 PVSFR，23 例（21.3%）在两个 PV 中出现 PVSFR，23 例（21.3%）在一个 PV 中出现 PVSFR。与左肺静脉相比，右肺静脉更常出现 PVSFR。出现多个 PVSFR 与较高的肺毛细血管楔压（PCWP）和 3D 瓣口收缩期面积（3D-VCA）显著相关。关于 MR 病因，在 DMR 和 A-FMR 患者中，PVSFR 的数量与较高的 3D-VCA 相关，而在 V-FMR 患者中，它与较高的 PCWP 相关。层流型 PVSFR 在 FMR 中比 DMR 更常见，与较高的 PCWP 和较低的右心室分数面积变化（RVFAC）有关。
96.8%的患者可检测到四个肺静脉，16.8%的患者在四个肺静脉中均出现 PVSFR。PCWP 和 3D-VCA 与重度 MR 患者的 PVSFR 数量相关。层流型 PVSFR 与较高的 PCWP 和较低的 RVFAC 有关。
