IRCCS Humanitas Research Hospital, Via Alessandro Manzoni, Milano, Italy.
Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, Milano, Italy.
Echocardiography. 2024 Nov;41(11):e70017. doi: 10.1111/echo.70017.
Mitral valve prolapse (MVP) has been associated with left heart remodeling. This study explored cardiac remodeling in patients with MVP without significant regurgitation, focusing on the right heart.
This single-center study enrolled consecutive patients referred to trans-thoracic-echocardiography (TTE) with MVP, excluding those with significant regurgitation or known cardiovascular or pulmonary diseases. A group of healthy controls was included.
Forty-nine patients with MVP and 54 controls were finally selected (mean age of 62, 52-71; 52% males), and echocardiographic parameters were compared among groups. Twenty-nine (41%) patients with MVP showed tricuspid valve prolapse (TVP). Patients with MVP, irrespective of TVP, showed greater tricuspid annulus (systolic annulus: 31±6 vs. 32±5 vs. 27±3 mm for MVP/TVP, MVP/TVP, and controls, respectively; all p < 0.01) and greater minimum right atrial volume indexed (13, 12-15 mL/m vs. 15, 12-20 mL/m vs. 11, 10-14 mL/m; all p < 0.05). Right ventricular dimensions and systolic indexes did not differ among groups, except TAPSE, which was significantly greater in MVP/TVP patients compared to controls (25±4 vs. 22±3 mm, p = 0.004). A significant correlation (ρ = 0.43; p < 0.001) and an independent association at multivariate analysis (ß = 0.28; 95% CI 0.09-0.47; p = 0.004) were observed between end-systolic tricuspid diameter and TAPSE.
In patients with MVP with less-than-moderate mitral or tricuspid regurgitation, dilation of the right atrium and tricuspid annulus was found. The latter finding was associated with increased values of TAPSE, which should then be used with caution, while other indexes may be preferred when assessing the systolic function of these patients.
二尖瓣脱垂（MVP）与左心重构有关。本研究探讨了无明显反流的 MVP 患者的心脏重构，重点关注右心。
这项单中心研究纳入了因 MVP 接受经胸超声心动图（TTE）检查的连续患者，排除了有明显反流或已知心血管或肺部疾病的患者。同时纳入了一组健康对照者。
最终选择了 49 例 MVP 患者和 54 例对照者（平均年龄 62 岁，52-71 岁；52%为男性），并比较了各组的超声心动图参数。29 例（41%）MVP 患者存在三尖瓣脱垂（TVP）。无论是否存在 TVP，MVP 患者的三尖瓣环（收缩期三尖瓣环：31±6 对 32±5 对 27±3 毫米，分别用于 MVP/TVP、MVP/TVP 和对照组；均 P＜0.01）和最小右心房容积指数（13，12-15 毫升/米 2 对 15，12-20 毫升/米 2 对 11，10-14 毫升/米 2 ；均 P＜0.05）均更大。各组间右心室的大小和收缩功能指数无差异，除了 MVP/TVP 患者的三尖瓣瓣环收缩期位移（TAPSE）显著大于对照组（25±4 对 22±3 毫米，P=0.004）。多元分析显示，收缩末期三尖瓣直径与 TAPSE 之间存在显著相关性（ρ=0.43；P＜0.001）和独立相关性（β=0.28；95%CI 0.09-0.47；P=0.004）。
在 MVP 患者中，对于二尖瓣或三尖瓣反流小于中度的患者，发现右心房和三尖瓣环扩张。后者与 TAPSE 值增加相关，在评估这些患者的收缩功能时应谨慎使用，而其他指数可能更受欢迎。
