超声评估缺血与瓣叶脱垂所致二尖瓣反流对左心房的影响  

The Effect of Mitral Regurgitation Induced by Ischemia and Valve Prolapse on the Left AriumEvaluatedbt y Ultrasound

作　　者：任甜荣 刘聪 徐凯 周微微 李阳 张婷婷 Ren Tianrong;Liu Cong;Xu Kai;Zhou Weiwei;Li Yang;Zhang Tingting(Institute of Cardiovascular Diseases,Northern Theater Command General Hospital,Shenyang 110016,China)

机构地区：[1]中国人民解放军北部战区总医院全军心血管病研究所,沈阳市110016

出　　处：《中国超声医学杂志》2024年第1期52-56,共5页Chinese Journal of Ultrasound in Medicine

基　　金：国家重点研发计划(No.2022YFC2503403)。

摘　　要：目的 探讨病因对中-重度及以上二尖瓣反流(MR)患者左心房重塑的影响。方法 前瞻性纳入经超声心动图确诊为中-重度及以上(≥3+)瓣叶脱垂相关退行性二尖瓣反流34例(DMR组)、缺血性二尖瓣反流31例(IMR组)及健康志愿者30例(对照组),分析比较不同病因MR对左心房重塑的影响。结果 DMR组较对照组左心房整体纵向应变(PALS)、左心房收缩期应变(LASct)、左心房整体射血分数(LAtEF)减小,左心房前后径(LAD)、左心房最大容积(LAVmax)、左心房最小容积(LAVmin)、左心房最大容积指数(LAVmaxi)、左心房最小容积指数(LAVmini)、左心房僵硬度指数(LASI)增高(P<0.05),左心房管道期应变(LAScd)无统计学意义(P>0.05);IMR组较DMR组PALS、LASct、LAScd、LAtEF减小,LAVmini、LASI增高(P<0.05),LAD、LAVmax、LAVmaxi、LAVmin差异无统计学意义(P>0.05)。相关性分析显示,LASI与左心室收缩末期容积指数(LVESVi)、左心室舒张末期容积指数(LVEDVi)、左室射血分数(LVEF)、LAVmaxi相关(r=0.634、0.559、-0.597、0.609,P<0.001),与LAVmini、LAtEF相关性更显著(r=0.747、-0.773,P<0.001)。结论 MR的病因影响左心房重塑,与反流程度相同的DMR比较,IMR的左心房重塑更显著。LASI是评估MR患者LA重塑的灵敏度指标,可为临床评估不同病因MR的左心房重塑及预测预后提供指导。Objective To investigate the etiological influence on left atrial remodeling in patients with moderate and severe mitral regurgitation(MR).Methods We prospectively enrolled 34 patients with moderate-to-severe mitral regurgitation associated with valve prolapse as degenerative mitral regurgitation group(DMR group),31 patients with ischemic mitral regurgitation as IMR group,and 30 healthy volunteers as control group,and compared the effect of MR on left atrial remodeling in different etiology.Results Compared with the control group,left atrial peak atrial longitudinal strain(PALS),left atrial strain during contraction phase(LASct),and left atrial total ejection fraction(LAtEF)in DMR group were reduced,and left atrial diameter(LAD),left atrial maximum volume(LAVmax),left atrial minimum volume(LAVmin),left atrial maximum volume index(LAVmaxi),left atrial minimum volume index(LAVmini),and left atrium stiffness index(LASI)were increased(P<0.05),while there was no significant difference in left atrial strain during conduit phase(LAScd)(P>0.05).Compared with the DMR group,PALS,LASct,LAScd,and LAtEF in the IMR group were reduced,LAVmini and LASI were increased(P<0.05),and LAD,LAVmax,LAVmaxi and LAVmin were not significantly different(P>0.05).Correlation analysis showed that LASI was correlated with left ventricular end systolic volume index(LVESVi),left ventricular end diastolic volume index(LVEDVi),left ventricular ejection fraction(LVEF),and LAVmaxi(r=0.634,0.559,-0.597,0.609,P<0.001),and was correlated with LAVmini and LAtEF(r=0.747,-0.773,P<0.001),the correlation of the latter was more significant.Conclusions The cause of MR affects left atrial remodeling.Compared with DMR with the same degree of regurgitation,left atrial remodeling in IMR is more significant.LASI is a sensitive indicator for evaluating LA remodeling in MR patients and can give advice to clinical evaluation of left atrial remodeling and prognosis predictions in different etiology MR.

关 键 词：退行性二尖瓣关闭不全 缺血性二尖瓣反流 左心房重塑 心肌缺血 

分 类 号：R542.51[医药卫生—心血管疾病] R445.1[医药卫生—内科学]