右心室舒张功能对射血分数保留型二尖瓣脱垂患者术后左心室射血分数减低的预测价值  

Predictive value of right ventricular diastolic function on postoperative LVEF reduction in patients with ejection fraction preserved mitral valve prolapse

作　　者：汪婷婷 金岩 赵洋 冷慧翎 曾文波 王辉山 WANG Ting-ting;JIN Yan;ZHAO Yang;LENG Hui-ling;ZENG Wen-bo;WANG Hui-shan(Graduate School of China Mediacal University,Shenyang 110016,China;Department of Cardiovascular Surgery,General Hospital of Northen Theater Command,Shenyang 110016,China)

机构地区：[1]中国医科大学研究生院,辽宁省沈阳市110016 [2]北部战区总医院心血管外科

出　　处：《中国心血管病研究》2022年第10期871-875,共5页Chinese Journal of Cardiovascular Research

基　　金：国家自然科学基金(82070239);辽宁省科学计划项目(2018225070)。

摘　　要：目的探讨窦性心律左心室射血分数保留型心力衰竭(HFpEF)的二尖瓣脱垂(MVP)患者术后1个月时左心室射血分数(LVEF)明显减低的危险因素。方法连续选择我院2016年1月~2021年8月期间行手术治疗的窦性心律HFpEF型MVP患者304例为研究对象,收集术前及术后1个月的临床资料和超声心动图数据,根据术后1个月时LVEF是否≥50%分为LVEF正常组(283例)和LVEF减低组(21例),观察其术前至术后各指标的变化情况。结果多因素分析发现,术后LVEF减低的危险因素是术前左心室收缩末期内径(LVESD)明显增大(P<0.001)、术前右心室舒张功能减低(Et/Et′增大)(P=0.023)及术后新发房颤(P=0.017,χ^(2)=9.648);ROC曲线显示,LVESD≥40.5 mm(敏感度81.0%,特异度83.4%)及Et/Et′≥4.83(敏感度85.7%,特异度48.4%)与窦性心律HFpEF型MVP患者术后出现LVEF减低有显著关系。结论术前LVESD明显增大、右心室舒张功能减低是窦性心律HFpEF型MVP患者术后LVEF发生减低的危险因素;右心室舒张功能减低预测术后LVEF减低的敏感性较高,常规测量Et/Et´可用于病情监测。Objective To explore the risk factors of significantly decreased left ventricular ejection fraction(LVEF)at 1 month after operation in patients with mitral valve prolapse(MVP)with sinus rhythm left ventricular ejection fraction preserved heart failure(HFPEF).Methods 304 HFpEF MVP patients with sinus rhythm who underwent surgery in our hospital from January 2016 to August 2021 were selected as this research objects.The clinical data and echocardiographic data before and 1 month after operation were collected.According to whether LVEF≥50%at 1 month after operation,they were divided into normal group(283 cases)and reduced group(21 cases),and the changes of each index before and after the operation were observed.Results Multivariate analysis showed that the risk factors of postoperative LVEF reduction were significantly increased left ventricular end systolic diameter(LVESD)(P<0.001),decreased right ventricular diastolic function(Et/Et′increase)(P=0.023)and new postoperative atrial fibrillation(P=0.017,χ^(2)=9.648);ROC curve showed that LVESD≥40.5 mm(sensitivity 81.0%,specificity 83.4%)and Et/Et′≥4.83(sensitivity 85.7%,specificity 48.4%)were significantly related to the decrease of postoperative LVEF in MVP patients.Conclusion The significant increase of LVESD and the decrease of right ventricular diastolic function before operation are the risk factors for the decrease of LVEF after operation in patients with sinus rhythm HFPEF MVP;The decrease of right ventricular diastolic function is highly sensitive to predict the decrease of LVEF after operation,routine measurement of Et/Et´can be used for condition monitoring of MVP patients.

关 键 词：右心室舒张功能 左心室收缩末期内径 术后新发房颤 射血分数保留型心力衰竭 二尖瓣脱垂 

分 类 号：R541.6[医药卫生—心血管疾病]