Department of Cardiology, Dr. Siyami Ersek Cardiovascular and Thoracic Surgery Center, İstanbul, Türkiye.
Anatol J Cardiol. 2023 Feb;27(2):71-77. doi: 10.14744/AnatolJCardiol.2022.2057.
In rheumatic severe mitral stenosis, right ventricular mechanics deteriorate with the increasing severity of mitral stenosis. Therefore, we aimed to investigate right ventricular mechanics in patients with mild mitral stenosis using 3-dimensional speckle tracking echocardiography.
In total, 40 patients with mild mitral stenosis and 36 age- and gender-matched healthy controls were included. Conventional echocardiographic examination was performed and 3-dimensional data sets were acquired for strain analysis. Besides conventional echocardiographic parameters, right ventricular volume and function and 3-dimensional speckle tracking echocardiography-derived right ventricular free wall longitudinal strain were compared between patients with mild mitral stenosis and healthy controls.
Although 3-dimensional right ventricular volumes and ejection fraction were similar between the groups, 3-dimensional speckle tracking echocardiography-derived right ventricular free wall longitudinal strain was significantly lower in patients with mild mitral stenosis than in controls (25.57 ± 4.39% vs. 27.90 ± 4.71%, P =.028). Significant correlations were observed between right ventricular free wall longitudinal strain and mitral valve area and estimated systolic pulmonary artery pressure (r = 0.597, P <.001; r = -0.508, P =.003, respectively). Another significant positive correlation was observed between planimetric mitral valve area and 3-dimensional speckle tracking echocardiography-derived right ventricular free wall longitudinal strain (r = 0.597, P <.001).
The degree of severity of mild mitral stenosis in terms of mitral valve area can help in the early detection of subclinical right ventricular systolic function impairment which can be easily detected by 3-dimensional speckle tracking echocardiography. Right ventricular contractile performance could decrease even in mild mitral stenosis.
在风湿性重度二尖瓣狭窄中，随着二尖瓣狭窄程度的增加，右心室力学会恶化。因此，我们旨在使用三维斑点追踪超声心动图研究轻度二尖瓣狭窄患者的右心室力学。
共纳入 40 例轻度二尖瓣狭窄患者和 36 例年龄和性别匹配的健康对照者。进行常规超声心动图检查，并获取应变分析的三维数据集。除常规超声心动图参数外，还比较了轻度二尖瓣狭窄患者和健康对照者的右心室容积和功能以及三维斑点追踪超声心动图衍生的右心室游离壁纵向应变。
尽管两组的三维右心室容积和射血分数相似，但轻度二尖瓣狭窄患者的三维斑点追踪超声心动图衍生的右心室游离壁纵向应变明显低于对照组（25.57 ± 4.39%比 27.90 ± 4.71%，P =.028）。右心室游离壁纵向应变与二尖瓣瓣口面积和估计的收缩期肺动脉压之间存在显著相关性（r = 0.597，P <.001；r = -0.508，P =.003）。平面二尖瓣瓣口面积与三维斑点追踪超声心动图衍生的右心室游离壁纵向应变之间也存在显著正相关（r = 0.597，P <.001）。
以二尖瓣瓣口面积表示的轻度二尖瓣狭窄的严重程度有助于早期发现亚临床右心室收缩功能障碍，而三维斑点追踪超声心动图很容易检测到这种障碍。即使在轻度二尖瓣狭窄中，右心室收缩性能也可能下降。
