Reddy Prajwal, Anand Vidhu, Rajiah Prabhakar, Larson Nicholas B, Bird Jared, Williams James M, Williamson Eric E, Nishimura Rick A, Crestanello Juan A, Arghami Arman, Collins Jeremy D, Bratt Alex
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States.
Department of Radiology, Division of Cardiovascular Imaging, Mayo Clinic, Rochester, MN, United States.
Front Cardiovasc Med. 2024 Feb 23;11:1297304. doi: 10.3389/fcvm.2024.1297304. eCollection 2024.
Volume overload from mitral regurgitation can result in left ventricular systolic dysfunction. To prevent this, it is essential to operate before irreversible dysfunction occurs, but the optimal timing of intervention remains unclear. Current echocardiographic guidelines are based on 2D linear measurement thresholds only. We compared volumetric CT-based and 2D echocardiographic indices of LV size and function as predictors of post-operative systolic dysfunction following mitral repair.
We retrospectively identified patients with primary mitral valve regurgitation who underwent repair between 2005 and 2021. Several indices of LV size and function measured on preoperative cardiac CT were compared with 2D echocardiography in predicting post-operative LV systolic dysfunction (LVEF <50%). Area under the curve (AUC) was the primary metric of predictive performance.
A total of 243 patients were included (mean age 57 ± 12 years; 65 females). The most effective CT-based predictors of post-operative LV systolic dysfunction were ejection fraction [LVEF; AUC 0.84 (95% CI: 0.77-0.92)] and LV end systolic volume indexed to body surface area [LVESVi; AUC 0.88 (0.82-0.95)]. The best echocardiographic predictors were LVEF [AUC 0.70 (0.58-0.82)] and LVESD [AUC 0.79 (0.70-0.89)]. LVEF was a significantly better predictor of post-operative LV systolic dysfunction than LVEF ( = 0.02) and LVESVi was a significantly better predictor than LVESD ( = 0.03). Ejection fraction measured by CT demonstrated significantly greater reproducibility than echocardiography.
CT-based volumetric measurements may be superior to established 2D echocardiographic parameters for predicting LV systolic dysfunction following mitral valve repair. Validation with prospective study is warranted.
二尖瓣反流导致的容量超负荷可引起左心室收缩功能障碍。为预防这种情况，在不可逆功能障碍发生之前进行手术至关重要，但最佳干预时机仍不明确。当前的超声心动图指南仅基于二维线性测量阈值。我们比较了基于容积CT和二维超声心动图的左心室大小及功能指标，以预测二尖瓣修复术后的收缩功能障碍。
我们回顾性纳入了2005年至2021年间接受二尖瓣修复术的原发性二尖瓣反流患者。将术前心脏CT测量的多个左心室大小及功能指标与二维超声心动图进行比较，以预测术后左心室收缩功能障碍（左心室射血分数<50%）。曲线下面积（AUC）是预测性能的主要指标。
共纳入243例患者（平均年龄57±12岁；女性65例）。基于CT的术后左心室收缩功能障碍最有效的预测指标是射血分数[左心室射血分数；AUC 0.84（95%可信区间：0.77-0.92）]和体表面积指数化的左心室收缩末期容积[左心室收缩末期容积指数；AUC 0.88（0.82-0.95）]。最佳的超声心动图预测指标是左心室射血分数[AUC 0.70（0.58-0.82）]和左心室收缩末期内径[AUC 0.79（0.70-0.89）]。左心室射血分数预测术后左心室收缩功能障碍的能力显著优于左心室射血分数（P=0.02），左心室收缩末期容积指数预测能力显著优于左心室收缩末期内径（P=0.03）。CT测量的射血分数的可重复性显著高于超声心动图。
基于CT的容积测量在预测二尖瓣修复术后左心室收缩功能障碍方面可能优于既定的二维超声心动图参数。有必要进行前瞻性研究验证。
