背景:重度二尖瓣反流(MR)患者的左心房(LA)力学仍未被研究。本评估的目的是评估重度MR对LA功能的影响,它与传统手术适应症的潜在关系,和术后长期生存。
方法:LA储层的二维斑点追踪应变和体积指数,导管,在121例重度MR患者和70例对照中评估了收缩功能。根据是否存在(n=46)或不存在(n=75)一项或多项基于指南的二尖瓣手术标准(症状,左心室射血分数≤60%,左心室收缩末期直径≥40mm,心房颤动,或收缩压>50mmHg)。
结果:重度MR患者与对照组相比,观察到显著的LA储库和收缩功能障碍,这在有二尖瓣手术指征的患者中更为明显(所有应变和体积指数P<0.05)。在LA函数的所有指数中,LA储层应变是一个独立的预测因子(比值比,0.88;95%置信区间,0.82-0.94;P<.001),并且在识别有二尖瓣手术指征的患者方面具有最高的准确性(接受者工作特征曲线下的面积,0.8;95%置信区间,0.72-0.87)。共有117例患者接受了二尖瓣手术。LA水库应变≤24%的患者在中位数为6.4年时表现出较差的生存率(四分位距,4.7-8.7年)二尖瓣手术后(P=.02),无论手术前的症状状态。LA储层应变,在二尖瓣手术适应症的基础上,为术后生存率提供增量预测价值。
结论:重度器质性MR患者LA储库劳损受损与二尖瓣手术后的长期生存有关,独立于当前基于指南的二尖瓣手术适应症。
BACKGROUND: Left atrial (LA) mechanics in patients with severe mitral regurgitation (MR) remain largely unexplored. The aim of the present evaluation was to assess the effect of severe MR on LA function, its potential relation with conventional surgical indications, and long-term postoperative survival.
METHODS: Two-dimensional speckle-tracking strain and volumetric indices of LA reservoir, conduit, and contractile function were assessed in 121 patients with severe MR and 70 controls. Patients were divided according to the presence (n = 46) or absence (n = 75) of one or more
guidelines-based criteria for mitral surgery (symptoms, left ventricular ejection fraction ≤ 60%, left ventricular end-systolic diameter ≥ 40 mm, atrial fibrillation, or systolic pulmonary arterial pressure >50 mm Hg).
RESULTS: In patients with severe MR compared with controls, significant LA reservoir and contractile dysfunction was observed, which was more pronounced in patients with mitral surgery indication (P < .05 for all strain and volumetric indices). Of all indices of LA function, LA reservoir strain was an independent predictor (odds ratio, 0.88; 95% confidence interval, 0.82-0.94; P < .001) and had the highest accuracy to identify patients with indications for mitral surgery (area under the receiver operating characteristic curve, 0.8; 95% confidence interval, 0.72-0.87). A total of 117 patients underwent mitral valve surgery. Patients with LA reservoir strain ≤24% showed worse survival at a median of 6.4 years (interquartile range, 4.7-8.7 years) after mitral surgery (P = .02), regardless the symptomatic status before surgery. LA reservoir strain, on top of mitral surgery indications, provided incremental predictive value for postoperative survival.
CONCLUSIONS: Impaired LA reservoir strain in patients with severe organic MR relates to long-term survival after mitral valve surgery, independently of and incremental to current
guidelines-based indications for mitral surgery.