Francisco Forteza J, Oliver A, Suzac C, Moreno M, García Fernández M A, Bañuelos F
Arch Inst Cardiol Mex. 1983 Mar-Apr;53(2):117-22.
We have analyzed independently, both, early diastolic and end diastolic (A wave) movements of the posterior mitral leaflet in 302 cases of mitral stenosis with sinus rhythm, as well as in a control group of 100 subjects without mitral stenosis. Studied patients were separated into two groups: 275 that were not treated surgically, and 27 studied after mitral commisurotomy. We described 4 patterns of posterior mitral leaflet early diastolic movement, and 3 patterns of A wave motion. Only those patterns that showed anterior drift of the studied segment of the posterior mitral leaflet, were considered diagnostic of mitral stenosis. The sensitivity found was 49% for the anterior early diastolic movement; 89,5% for the anterior A wave, and 95,3% for both signs considered together. The specificity was 99% for anterior A wave, with a predictive value of 99,6%. When surgical and non surgical groups were compared, the absence of anterior drift in early diastole in the former group, showed to have statistical significance when the Chi square test was employed, while A wave pattern (anterior drift) did not show any difference between both groups. It is concluded that the most sensitive and specific sign for M-mode echocardiagraphic diagnosis of mitral stenosis in patients with sinus rhythm is the anterior drift of posterior mitral leaflet's A wave.
我们独立分析了302例窦性心律二尖瓣狭窄患者以及100例无二尖瓣狭窄的对照组患者二尖瓣后叶舒张早期和舒张末期（A波）的运动情况。研究对象分为两组：275例未接受手术治疗的患者，以及27例接受二尖瓣分离术后的患者。我们描述了二尖瓣后叶舒张早期运动的4种模式和A波运动的3种模式。只有那些显示二尖瓣后叶研究节段向前移位的模式才被视为二尖瓣狭窄的诊断依据。发现舒张早期向前运动的敏感性为49%；A波向前运动的敏感性为89.5%，两者综合考虑的敏感性为95.3%。A波向前运动的特异性为99%，预测值为99.6%。当比较手术组和非手术组时，采用卡方检验发现，前一组舒张早期无向前移位具有统计学意义，而两组之间A波模式（向前移位）无差异。得出结论，对于窦性心律患者，M型超声心动图诊断二尖瓣狭窄最敏感和特异的征象是二尖瓣后叶A波向前移位。
