Essop M R, Wisenbaugh T, Sareli P
Division of Cardiology, Baragwanath Hospital, Johannesburg, South Africa.
J Am Coll Cardiol. 1993 Sep;22(3):826-9. doi: 10.1016/0735-1097(93)90197-9.
The aim of this study was to determine whether left ventricular dilation and congestive heart failure in patients with acute rheumatic fever with carditis are accompanied by left ventricular contractile dysfunction.
Acute rheumatic fever with carditis involves both the myocardium and endocardium, with consequent valvular regurgitation. The relative contribution of volume overload induced by valvular regurgitation and myocardial dysfunction due to rheumatic myocarditis to the overall degree of left ventricular dilation and congestive heart failure in these patients is unknown.
To investigate this, we evaluated 32 patients (15 male, 17 female, mean age 14 +/- 3 years) with documented active carditis and congestive heart failure. All 32 patients were found to have significant isolated mitral regurgitation or combined mitral and aortic regurgitation. Echocardiographic analysis of left ventricular dimensions and systolic performance was performed before and after isolated mitral or combined mitral and aortic valve replacement and the results were compared with those in 19 control subjects matched for age, gender and body surface area.
Both preoperative left ventricular end-diastolic diameter and percent fractional shortening were significantly increased in patients compared with control subjects (57 +/- 7 vs. 43 +/- 3 mm, p < 0.001, and 38 +/- 6% vs. 33 +/- 1%, p < 0.001, respectively). After valve replacement, left ventricular end-diastolic diameter decreased significantly (57 +/- 7 to 47 +/- 6 mm, p < 0.001). Although percent fractional shortening decreased significantly postoperatively (38 +/- 6% to 32 +/- 6%, p < 0.001), the postoperative percent fractional shortening did not differ from that in control subjects (32 +/- 6% vs. 33 +/- 1%, p = NS).
The results of this study indicate that left ventricular dilation and heart failure in patients with acute rheumatic carditis rarely occur in the absence of hemodynamically significant regurgitant valve lesions. Furthermore, rapid reduction in left ventricular dimensions and preservation of fractional shortening after isolated mitral or combined mitral and aortic valve replacement suggest that rheumatic carditis is not accompanied by any significant degree of myocardial contractile dysfunction.
本研究旨在确定患有急性风湿热合并心脏炎的患者出现左心室扩张和充血性心力衰竭时是否伴有左心室收缩功能障碍。
急性风湿热合并心脏炎累及心肌和心内膜，进而导致瓣膜反流。瓣膜反流引起的容量超负荷以及风湿性心肌炎导致的心肌功能障碍，在这些患者左心室扩张和充血性心力衰竭的总体程度中所起的相对作用尚不清楚。
为研究这一问题，我们评估了32例（15例男性，17例女性，平均年龄14±3岁）确诊为活动性心脏炎和充血性心力衰竭的患者。所有32例患者均发现有显著的单纯二尖瓣反流或二尖瓣与主动脉瓣联合反流。在单纯二尖瓣或二尖瓣与主动脉瓣联合置换术前和术后，对左心室大小和收缩功能进行超声心动图分析，并将结果与19例年龄、性别和体表面积相匹配的对照受试者进行比较。
与对照受试者相比，患者术前左心室舒张末期直径和缩短分数百分比均显著增加（分别为57±7 vs. 43±3 mm，p<0.001；38±6% vs. 33±1%，p<0.001）。瓣膜置换术后，左心室舒张末期直径显著减小（57±7至47±6 mm，p<0.001）。虽然缩短分数百分比术后显著降低（38±6%至32±6%，p<0.001），但术后缩短分数百分比与对照受试者无差异（32±6% vs. 33±1%，p=无显著性差异）。
本研究结果表明，急性风湿性心脏炎患者的左心室扩张和心力衰竭很少在无血流动力学显著反流性瓣膜病变的情况下发生。此外，单纯二尖瓣或二尖瓣与主动脉瓣联合置换术后左心室大小迅速减小且缩短分数得以保留，提示风湿性心脏炎不伴有任何显著程度的心肌收缩功能障碍。
