Dirsienė Rūta, Martinaitytė Rugilė, Tamulėnaitė Eglė, Montvilaitė Aistė, Karčiauskas Dainius, Ereminienė Eglė, Vaškelytė Justina Jolanta
Faculty of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania.
Institute of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania.
Perfusion. 2025 Apr;40(3):605-612. doi: 10.1177/02676591241251441. Epub 2024 Apr 30.
IntroductionPatients with primary mitral regurgitation (MR) usually remain asymptomatic for a long time due to compensatory mechanisms and an adequate treatment could be delayed. Stress echocardiography and speckle-tracking analysis could help to evaluate impaired left atrium (LA) function before the manifestation of clinically significant myocardial changes in asymptomatic patients with primary MR and preserved left ventricular (LV) ejection fraction (EF).MethodsThis study prospectively enrolled 91 patients with preserved LV EF (≥60%) at rest, of which 60 patients had moderate-to-severe MR and 31 were healthy controls. Rest and stress (bicycle ergometry) echocardiography and speckle-tracking offline analysis were performed.ResultsIn MR group LA volume indices were higher at rest and during stress, while LA reservoir, conduit, and contractile fractions were decreased ( < .005). LA deformation parameters at rest were similar in both groups. During maximum stress LA conduit, contractile fractions and reservoir strain were lower ( < .05) in patients with MR. Indices of LA volume were related to SPAP at rest and during stress. Higher NT-proBNP concentrations was associated with higher LA volume indices, decreased contractile and reservoir functions during peak stress ( < .05). LA volume indices, LA EF, and filling index at rest could predict exercise-induced pulmonary hypertension (EIPH) ( < .05).ConclusionsIn patients with primary MR and preserved LV EF, LA parameters are related to SPAP and NT-pro-BNP concentration. LA volume indices, LA EF and LA filling index are predictors of EIPH.
引言
原发性二尖瓣反流（MR）患者通常由于代偿机制而长期无症状，可能会延误适当的治疗。对于静息左心室（LV）射血分数（EF）正常的无症状原发性MR患者，在出现具有临床意义的心肌变化之前，负荷超声心动图和斑点追踪分析有助于评估左心房（LA）功能受损情况。
方法
本研究前瞻性纳入91例静息时LV EF≥60%的患者，其中60例患有中重度MR，31例为健康对照。进行了静息和负荷（踏车运动）超声心动图检查以及斑点追踪离线分析。
结果
在MR组中，静息和负荷时LA容积指数较高，而LA储存、管道和收缩分数降低（P<0.005）。两组静息时LA变形参数相似。在最大负荷时，MR患者的LA管道、收缩分数和储存应变较低（P<0.05）。LA容积指数与静息和负荷时的肺动脉收缩压（SPAP）相关。较高的N末端脑钠肽前体（NT-proBNP）浓度与较高的LA容积指数、负荷峰值时收缩和储存功能降低相关（P<0.05）。静息时的LA容积指数、LA EF和充盈指数可预测运动诱发的肺动脉高压（EIPH）（P<0.05）。
结论
在原发性MR且LV EF正常的患者中，LA参数与SPAP和NT-pro-BNP浓度相关。LA容积指数、LA EF和LA充盈指数是EIPH的预测指标。
