Ting Chih-Tai, Chen Jaw-Wen, Chang Mau-Song, Yin Frank C-P
Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan.
Department of Medical Research, Veterans General Hospital, Taipei, Taiwan.
Ann Biomed Eng. 2025 Mar;53(3):758-784. doi: 10.1007/s10439-024-03661-3. Epub 2024 Dec 15.
We compared adults with mitral stenosis (MS) to 8 controls (CONT) to see how pulmonary impedance and wave reflections differ at baseline and after balloon valvuloplasty.
We separated the MS patients into groups according to mean pulmonary artery pressure: moderate (MOD; ≤ 26 mmHg, n = 21) and high (HIGH; > 26 mmHg, n = 33). We made baseline high-fidelity measurements in all patients, in the MS groups after vasodilation with nitroprusside, immediately and 4 months after balloon valvuloplasty.
Comparing MOD vs CONT, using the Kruskal-Wallis test with Bonferroni correction, reveals evidence for higher baseline input resistance (R) (489 vs 205 dyne-sec/cm, P = 0.07); first harmonic of impedance modulus (Z) (97.3 vs 27.6 dyne-sec/cm, P = 0.01); first zero crossing of impedance phase angle (F) (4.49° vs 2.19°, P = 0.02) but no difference in wave reflection index (P/P). Baseline HIGH vs CONT comparisons reveal stronger evidence and larger differences than MOD for R (995 vs 205, P < 0.001); Z (151 vs 27.6, P < 0.001); F (5.25 vs 2.19, P < 0.001); as well as P/P (0.69 vs 0.42, P < 0.001). Responses to nitroprusside and valvuloplasty are also greater in the HIGH than MOD, but the HIGH parameters still differ from the CONT. Four months after valvuloplasty there is evidence for reverse remodeling in both groups. Further analyses reveal that sinus rhythm and younger age are potentially important factors for remodeling.
MS causes alterations in pulmonary hemodynamics that differ according to pressure levels. These changes are only partially reversed immediately after valvuloplasty. There is evidence for reverse remodeling 4 months afterwards.
我们将二尖瓣狭窄（MS）成人患者与8名对照者（CONT）进行比较，以观察肺阻抗和波反射在基线时以及球囊瓣膜成形术后的差异。
我们根据平均肺动脉压将MS患者分为两组：中度（MOD；≤26 mmHg，n = 21）和高度（HIGH；> 26 mmHg，n = 33）。我们对所有患者进行了基线高保真测量，在MS组中，在使用硝普钠进行血管舒张后、球囊瓣膜成形术后即刻和4个月时进行测量。
使用带有Bonferroni校正的Kruskal-Wallis检验比较MOD与CONT，结果显示有证据表明基线输入阻力（R）更高（489 vs 205达因-秒/厘米，P = 0.07）；阻抗模量（Z）的一次谐波（97.3 vs 27.6达因-秒/厘米，P = 0.01）；阻抗相位角的第一个过零点（F）（4.49° vs 2.19°，P = 0.02），但波反射指数（P/P）无差异。基线时HIGH与CONT的比较显示，与MOD相比，R（995 vs 205，P < 0.001）、Z（151 vs 27.6，P < 0.001）、F（5.25 vs 2.19，P < 0.001）以及P/P（0.69 vs 0.42，P < 0.001）的证据更强且差异更大。HIGH组对硝普钠和瓣膜成形术的反应也大于MOD组，但HIGH组的参数仍与CONT组不同。瓣膜成形术后4个月，两组均有逆向重构的证据。进一步分析表明，窦性心律和较年轻的年龄可能是重构的重要因素。
MS导致肺血流动力学改变，这种改变因压力水平而异。这些变化在球囊瓣膜成形术后即刻仅部分逆转。4个月后有逆向重构的证据。
