Poyraz Esra, Can Fatma, Keles Nursen, Asarcikli Lale Dinc, Sekerci Sena Sert, Gurkan Tulay Bayram, Dayı Sennur Unal
Dr. Siyami Ersek Cardiovascular and Thoracic Surgery Center, Department of Cardiology, Health Science University, Istanbul, Turkey.
Int J Cardiovasc Imaging. 2024 Dec;40(12):2571-2579. doi: 10.1007/s10554-024-03263-z. Epub 2024 Oct 26.
We aimed to evaluate the effect of exercise echocardiography (EE) on Right ventricular (RV) deformation parameters in asymptomatic patients with severe rheumatic mitral stenosis (MS) (mitral valve area ≤ 1.5 cm, stage C) and to determine the relation between symptoms and severity of MS. 38 rheumatic MS patients in stage C underwent EE. 20 Patients were defined; as an exercise intolerance group who couldn't reach a maximum heart rate according to their age during exercise due to developing dyspnea The remaining 18 patients who reached a maximum heart rate without dyspnea were defined; as an exercise tolerance group. RV echocardiographic parameters at baseline and peak exercise were compared between the groups. While RV global strain (RV GLS) (21.02 ± 3.33 vs. 21.92 ± 3.03) and RV free wall longitudinal strain (RV FWLS) (23.41 ± 5.66 vs. 25.08 ± 5.00) at baseline were similar in both groups (P = 0.390 P = 0.343), RV GLS (23.38 ± 4.30 vs. 26.05 ± 3.24) and RV FWLS (24.24 ± 5.78 vs. 28.05 ± 4.62) at peak exercise were reduced in exercise intolerance group (P = 0.040 P = 0.033). The best correlations were found between exercise capacity and RV FWLS at baseline and peak exercise in all MS patients (respectively; r = 0.627 P < 0.001; r = 0.697 P < 0.001). RV mechanics has approved the reliability of EE in patients with asymptomatic patients with severe MS. During exercise RV contractile reserve could diminish in MS patients with stage C who develop dyspnea. Moreover, since our study has a close relationship between exercise capacity and RV mechanics, using RV mechanics during exercise echocardiography may be useful for risk stratification in MS patients with severe MS.
我们旨在评估运动超声心动图（EE）对无症状重度风湿性二尖瓣狭窄（MS）患者（二尖瓣面积≤1.5 cm²，C期）右心室（RV）变形参数的影响，并确定症状与MS严重程度之间的关系。38例C期风湿性MS患者接受了EE检查。20例患者被定义为运动不耐受组，这些患者在运动期间因出现呼吸困难而无法根据其年龄达到最大心率。其余18例未出现呼吸困难且达到最大心率的患者被定义为运动耐受组。比较两组患者基线和运动峰值时的RV超声心动图参数。两组患者基线时的RV整体应变（RV GLS）（21.02±3.33 vs. 21.92±3.03）和RV游离壁纵向应变（RV FWLS）（23.41±5.66 vs. 25.08±5.00）相似（P = 0.390，P = 0.343），但运动不耐受组运动峰值时的RV GLS（23.38±4.30 vs. 26.05±3.24）和RV FWLS（24.24±5.78 vs. 28.05±4.62）降低（P = 0.040，P = 0.033）。在所有MS患者中，运动能力与基线和运动峰值时的RV FWLS之间的相关性最佳（分别为：r = 0.627，P < 0.001；r = 0.697，P < 0.001）。RV力学已证实EE在无症状重度MS患者中的可靠性。在运动期间，C期出现呼吸困难的MS患者的RV收缩储备可能会降低。此外，由于我们研究发现运动能力与RV力学之间存在密切关系，因此在运动超声心动图检查期间使用RV力学可能有助于重度MS患者的风险分层。
