Post Graduation Program in Infectious Diseases and Tropical Medicine, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil; Hospital das Clinicas, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
Hospital das Clinicas, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
Int J Cardiol. 2024 Jan 1;394:131361. doi: 10.1016/j.ijcard.2023.131361. Epub 2023 Sep 12.
Rheumatic mitral stenosis (MS) leads to LA remodeling with disordered electrical activation that may revert with valve intervention. This study aimed to assess the acute and late impact of percutaneous mitral balloon valvuloplasty (PMBV) on LA volume and function in patients with atrial fibrillation (AF) compared with sinus rhythm.
A total of 167 patients with severe MS undergoing PMBV were prospectively enrolled. LA volumes and function were measured by three-dimensional echocardiography (3DE) pre PMBV, within 24 to 48 h after PMBV, and at 1 year.
Mean age was 43.5 ± 11.8 years old, and 142 (85%) patients were women. At baseline, 46 patients (27.5%) were in permanent AF, and 62 (37.1%) classified as New York Heart Association functional class III or IV. In sinus rhythm population, LA volumes decreased immediately after PMBV and continue to decrease at 1-year follow-up. LA emptying fraction increased from 23.6 ± 10.4% to 33.8 ± 11.9% acutely after the procedure (p < 0.001), and to 37.2 ± 13.2% at 1-year follow-up (p = 0.028). Patients with AF only had a significant decrease in LA minimum volume immediately after PMBV, with no significant changes in maximum volume either immediately or at follow-up. In these patients, LA emptying fraction increased immediately after the procedure from 15.8 ± 9.9% to 22.8 ± 9.8 (p = 0.001) with no evidence for additional improvement at the 1-year follow-up. Age, and post-procedural mean gradient were identified as the most significant factors associated with the absolute changes in LA function between baseline and the 1-year follow-up.
In patients with severe MS, the impact of PMBV on LA volume and function varies according to cardiac rhythm. In patients in sinus rhythm, the procedure leads to improvement of LA volumes and function both acutely and at 1-year follow-up. Patients with AF had a lesser improvement in LA function immediately after the procedure, without further improvement over time despite adequate relief of valve obstruction.
风湿性二尖瓣狭窄（MS）导致左心房重构，伴电活动紊乱，瓣膜介入治疗后可能恢复正常。本研究旨在评估经皮二尖瓣球囊成形术（PMBV）对心房颤动（AF）患者与窦性心律患者左心房（LA）容积和功能的即刻和晚期影响。
前瞻性纳入 167 例接受 PMBV 的严重 MS 患者。通过三维超声心动图（3DE）在 PMBV 前、PMBV 后 24-48 小时和 1 年时测量 LA 容积和功能。
平均年龄为 43.5±11.8 岁，142 例（85%）为女性。基线时，46 例（27.5%）为永久性 AF，62 例（37.1%）为纽约心脏协会心功能分级 III 或 IV 级。在窦性心律人群中，LA 容积在 PMBV 后即刻减小，并在 1 年随访时持续减小。LA 排空分数在术后即刻从 23.6±10.4%增加至 33.8±11.9%（p<0.001），并在 1 年随访时增加至 37.2±13.2%（p=0.028）。仅 AF 患者的 LA 最小容积在 PMBV 后即刻显著减小，最大容积在即刻或随访时均无明显变化。在这些患者中，LA 排空分数在术后即刻从 15.8±9.9%增加至 22.8±9.8%（p=0.001），在 1 年随访时没有进一步增加。年龄和术后平均梯度是与基线至 1 年随访期间 LA 功能绝对值变化最显著相关的因素。
在严重 MS 患者中，PMBV 对 LA 容积和功能的影响因心律而异。在窦性心律患者中，该手术可即刻和 1 年随访时改善 LA 容积和功能。AF 患者在手术后即刻 LA 功能改善较小，尽管瓣膜梗阻得到充分缓解，但随时间推移并无进一步改善。
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