Zile M R, Gaasch W H, Carroll J D, Levine H J
J Am Coll Cardiol. 1984 Feb;3(2 Pt 1):235-42. doi: 10.1016/s0735-1097(84)80006-6.
The effect of mitral valve replacement on left ventricular volume, mass, function and clinical symptoms was examined in 20 patients with chronic mitral regurgitation. Pre- and postoperative echocardiograms demonstrated that two outcomes could be defined. Left ventricular dimension at end-diastole was reduced to normal postoperatively in the 16 Group I patients, but was unchanged in the 4 Group II patients. The Group I response was associated with a dramatic reduction in left ventricular mass and a decrease in clinical symptoms; all 16 patients reached New York Heart Association functional class I. No change in left ventricular mass was seen in the Group II patients and all four remained symptomatic despite continued medical therapy. Examination of the preoperative echocardiographic measurements indicates that these data have significant prognostic value in predicting surgical outcome. When ventricular dimension at end-systole exceeds 2.6 cm/m2 or fractional shortening is less than 31% or end-systolic wall stress index exceeds 195 mm Hg, all Group II patients are identified and there are no false positive results in Group I. It is concluded that echocardiographic measurements of left ventricular size, function and wall stress can provide important prognostic information in patients with chronic mitral regurgitation. Such data may allow improved patient selection and a better definition of an optimal time for mitral valve replacement.
对20例慢性二尖瓣反流患者进行了二尖瓣置换术对左心室容积、质量、功能及临床症状影响的研究。术前和术后超声心动图显示可明确两种结果。16例I组患者术后舒张末期左心室内径降至正常，但4例II组患者未发生变化。I组的反应与左心室质量显著降低及临床症状减轻相关；所有16例患者均达到纽约心脏病协会心功能I级。II组患者左心室质量未见变化，尽管持续进行药物治疗，所有4例患者仍有症状。术前超声心动图测量结果显示，这些数据对预测手术结果具有显著的预后价值。当收缩末期心室内径超过2.6 cm/m2或缩短分数小于31%或收缩末期壁应力指数超过195 mmHg时，可识别出所有II组患者，且I组无假阳性结果。结论是，超声心动图对左心室大小、功能及壁应力的测量可为慢性二尖瓣反流患者提供重要的预后信息。这些数据可能有助于改善患者选择，并更好地确定二尖瓣置换的最佳时机。
