Department of Ultrasonic Medicine, the First Affiliated Hospital of Guangxi Medical University, Nanning, China.
Department of Ultrasonic Medicine, the First Affiliated Hospital of University of South China, Hengyang, China.
Echocardiography. 2024 Oct;41(10):e15943. doi: 10.1111/echo.15943.
BACKGROUND/AIM: Mitral regurgitation (MR) is frequently observed in non-valvular atrial fibrillation (NVAF) patients and is a significant risk factor for its progression. This study aims to investigate the three-dimensional anatomical characteristics of the mitral valve (MV) in patients with different types of NVAF to elucidate the underlying mechanisms of MR. METHODS: A retrospective analysis was conducted on 82 paroxysmal atrial fibrillation patients (PAF group) and 66 persistent atrial fibrillation patients (PerAF group) who underwent real-time three-dimensional transesophageal echocardiography (RT 3D-TEE) before initial ablation. Additionally, 30 patients undergoing RT 3D-TEE for the assessment of patent foramen ovale were selected as the control group. Basic echocardiographic variables were measured, left atrioventricular volume and strain parameters were calculated using automated software (Dynamic-HeartModel and AutoStrain). MV anatomic features were analyzed using the 4D-MV Assessment software (TomTec Imaging Systems). RESULTS: The maximum left atrial volume (LAVmax) was highest in the PerAF group, followed by the PAF and control groups, with statistically significant differences (p < 0.01). Left atrial reservoir strain (LASr) showed an opposite trend, being the lowest in the PerAF group (p < 0.01). The proportion of moderate to severe MR was significantly higher in the PerAF group (27.3%) compared to the PAF group (11.0%) (p < 0.01). Compared to controls, the AF groups exhibited mitral annular (MA) dilation, flattening of the MA plane, and increased leaflet area (all p < 0.05). Correlation analysis between effective regurgitant orifice area (EROA) and left atrioventricular structure and function parameters, as well as various annular parameters, showed that EROA was significantly correlated with left ventricular end-diastolic volume (LVEDV), LAVmax, LASr, anterior and posterior diameter, annular area, ratio of annular height to commissural diameter (AH/CD ratio), posterior leaflet area, posterior leaflet length, and the C-shaped annulus length (all p < 0.05). CONCLUSIONS: Significant remodeling of the MV apparatus occurs in NVAF patients, with more pronounced changes in PerAF patients, contributing to a higher incidence of moderate to severe MR. RT 3D-TEE-based MV automated assessment offers significant advantages in accurately diagnosing MV remodeling and supporting the evaluation of MR in NVAF patients.
背景/目的：二尖瓣反流（MR）在非瓣膜性心房颤动（NVAF）患者中经常观察到，是其进展的一个重要危险因素。本研究旨在探讨不同类型 NVAF 患者的二尖瓣（MV）的三维解剖特征，以阐明 MR 的潜在机制。
方法：回顾性分析了 82 例阵发性心房颤动患者（PAF 组）和 66 例持续性心房颤动患者（PerAF 组）的实时三维经食管超声心动图（RT 3D-TEE）资料，这些患者在初次消融前均接受了检查。此外，还选择了 30 例因卵圆孔未闭而接受 RT 3D-TEE 评估的患者作为对照组。使用自动化软件（Dynamic-HeartModel 和 AutoStrain）测量基本超声心动图变量，计算左心房容积和应变参数。使用 4D-MV 评估软件（TomTec Imaging Systems）分析 MV 解剖特征。
结果：最大左心房容积（LAVmax）在 PerAF 组中最高，其次是 PAF 组和对照组，差异有统计学意义（p<0.01）。左心房储备应变（LASr）呈相反趋势，PerAF 组最低（p<0.01）。与 PAF 组（11.0%）相比，PerAF 组中中重度 MR 的比例明显更高（27.3%）（p<0.01）。与对照组相比，AF 组的二尖瓣环（MA）扩张、MA 平面变平、瓣叶面积增大（均 p<0.05）。有效反流口面积（EROA）与左心房结构和功能参数以及各种环形参数之间的相关性分析表明，EROA 与左心室舒张末期容积（LVEDV）、LAVmax、LASr、前、后直径、环形面积、环形高度与瓣环口直径比值（AH/CD 比值）、后瓣叶面积、后瓣叶长度和 C 形环长度显著相关（均 p<0.05）。
结论：NVAF 患者的 MV 装置发生明显重塑，PerAF 患者的变化更为明显，导致中重度 MR 的发生率更高。基于 RT 3D-TEE 的 MV 自动评估在准确诊断 MV 重塑和支持 NVAF 患者 MR 评估方面具有显著优势。
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