Vriz Olga, Feras Khaliel, Alamri Mohammed, Blassy Benny, Almozel Anwar, Smith Matthew, Kinsara Abdulhalim Jamal, Galzerano Domenico, Alsomali Afrah, Veldtman Gruschen R
King Faisal Specialist Hospital and Research Center, Cardiac Centre, Riyadh, Saudi Arabia.
University of Glasgow, Adult Congenital Cardiac Service, Glasgow, Scotland.
J Cardiovasc Echogr. 2022 Jan-Mar;32(1):38-46. doi: 10.4103/jcecho.jcecho_80_21. Epub 2022 Apr 20.
Rheumatic mitral valve (MV) stenosis is associated with progressive left atrial (LA) fibrosis and functional impairment, Pulmonary artery systolic pressure (PASP) and right ventricular (RV) dysfunction. The aims of the study were to determine in those patients with severe MV stenosis if LA mechanical function as assessed by speckle tracking echocardiography could identify those with increased PASP, atrial fibrillation (AFib), and RV dysfunction.
Patients with severe MV stenosis were identified from the institutional echo database. Echocardiograms were read off line and measurements included atrial and ventricular strain. Patients were divided into tertiles of LA reservoir strain (LASr) values and data compared between the groups.
Ninety-seven patients, 67 females, mean age 47.4 ± 11.9 years, had MV mean gradient of 8.3 ± 5.1 mmHg, MV area by pressure half time of 1.3 ± 0.3 cm and LASr of 11.18% ± 6.4%. Those patients in the lowest LASr tertile had more AFib (72%, = 0.0001), PASP >50 mm Hg (39%, = 0.005), and worst RV impairment. In multivariable logistic regression analysis, LASr, age, and mean MV gradient were the independent predictors of AFib and PASP >50 mm Hg. Cutoffs, determined by receiver operating characteristic curve analysis had high specificity for the composite outcome of Afib and PASP >50 mmHg (85% for LASr <7.7%).
In severe MV stenosis LASr, age and mean MV gradient, are independent predictors of Afib and PASP >50 mmHg. LASr <7.7% has high sensitivity and specificity in identifying those who meet ESC guideline 2017 criteria for valve intervention, suggesting its potentially helpful addendum to the surveillance of patients with MV stenosis.
风湿性二尖瓣狭窄与进行性左心房纤维化、功能损害、肺动脉收缩压（PASP）及右心室（RV）功能障碍相关。本研究旨在确定在重度二尖瓣狭窄患者中，经斑点追踪超声心动图评估的左心房机械功能是否能够识别出PASP升高、心房颤动（AFib）及右心室功能障碍的患者。
从机构超声数据库中识别出重度二尖瓣狭窄患者。超声心动图离线读取，测量包括心房和心室应变。患者按左心房储备应变（LASr）值分为三分位数组，并比较组间数据。
97例患者，67例女性，平均年龄47.4±11.9岁，二尖瓣平均压差为8.3±5.1 mmHg，压力减半时间法测得的二尖瓣面积为1.3±0.3 cm，LASr为11.18%±6.4%。LASr最低三分位数组的患者AFib更多（72%，P=0.0001），PASP>50 mmHg（39%，P=0.005），右心室损害更严重。在多变量逻辑回归分析中，LASr、年龄和二尖瓣平均压差是AFib和PASP>50 mmHg的独立预测因素。通过受试者工作特征曲线分析确定的截断值对AFib和PASP>50 mmHg的复合结局具有高特异性（LASr<7.7%时为85%）。
在重度二尖瓣狭窄中，LASr、年龄和二尖瓣平均压差是AFib和PASP>50 mmHg的独立预测因素。LASr<7.7%在识别符合2017年欧洲心脏病学会瓣膜干预指南标准的患者时具有高敏感性和特异性，表明其可能有助于二尖瓣狭窄患者的监测。
