Delhomme C, Casset-Senon D, Babuty D, Charniot J C, Fauchier L, Fauchier J P, Philippe L, Cosnay P
Service de cardiologia B, hôpital Trousseau, Tours.
Arch Mal Coeur Vaiss. 1996 Sep;89(9):1127-35.
Left and right ventricular wall motion was studied in mitral valve prolapse with or without ventricular arrhythmias. Regional and global ventricular wall motion was evaluated by isotopic methods, based in ejection fraction and Fourier phase analysis representing the progression of wall contraction. The synchronisation of the ventricles was characterized by the difference of the mean phase of each ventricle. The heterogeneity of contraction of each ventricle was defined by the dispersion around the mean (standard deviations of the phases). Fifteen of the 36 patients had complex ventricular arrhythmias (Lown grade > or = III). 12 had LVP and 16 had mitral regurgitation. In mitral valve prolapse, the RV EF was decreased compared with normal controls (30 +/- 9% vs 40 +/- 10% ; p < 0.001), especially in patients with mitral regurgitation (26 +/- 7% vs 30 +/- 10%; p = NS) and complex ventricular arrhythmias (26 +/- 7% vs 32 +/- 10%; p < 0.01). The SDP of the LV was greater than those of controls (18 +/- 11 degrees vs 11 +/- 5 degrees ; p = NS) whereas the SDP of the RV was greater (27 +/- 17 degrees vs 12 +/- 5 degrees ; p < 0.05) especially in those with complex ventricular arrhythmias (36 +/- 21 degrees vs 21 +/- 10 degrees : p < 0.01). The SDP of LV and RV were greater in patients with mitral regurgitation: 20 +/- 11 degrees versus 17 +/- 10 degrees (NS) and 35 +/- 21 degrees versus 20 +/- 8 degrees (p < 0.01). Heterogenous ventricular contraction, more marked in the right ventricle in mitral valve prolapse suggests severe myocardial disruption in this valvular disease, reflected by the high incidence of LVP and complex ventricular arrhythmias.
对伴有或不伴有室性心律失常的二尖瓣脱垂患者的左、右心室壁运动进行了研究。采用同位素方法，基于射血分数和代表心室壁收缩进程的傅里叶相位分析，对局部和整体心室壁运动进行评估。通过每个心室平均相位的差异来表征心室的同步性。每个心室收缩的异质性通过围绕平均值的离散度（相位标准差）来定义。36例患者中有15例出现复杂性室性心律失常（洛恩分级≥Ⅲ级）。12例有左心室脱垂，16例有二尖瓣反流。在二尖瓣脱垂患者中，右心室射血分数较正常对照组降低（30±9%对40±10%；p<0.001），尤其是二尖瓣反流患者（26±7%对30±10%；p=无显著性差异）和复杂性室性心律失常患者（26±7%对32±10%；p<0.01）。左心室的标准差大于对照组（18±11°对11±5°；p=无显著性差异），而右心室的标准差更大（27±17°对12±5°；p<0.05），尤其是在复杂性室性心律失常患者中（36±21°对21±10°：p<0.01）。二尖瓣反流患者左、右心室的标准差更大：分别为20±11°对17±10°（无显著性差异）和35±21°对20±8°（p<0.01）。二尖瓣脱垂时心室收缩异质性在右心室更明显，提示该瓣膜病存在严重的心肌损害，这在左心室脱垂和复杂性室性心律失常的高发生率中得到体现。
