Echocardiographic classification of chronic ischemic mitral regurgitation caused by restricted motion according to tethering pattern.
Echocardiographic classification of chronic ischemic mitral regurgitation caused by restricted motion according to tethering pattern.
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DOI：
10.1016/j.euje.2004.03.001
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发表时间：
2004-10-01
期刊：
影响因子：
--
通讯作者：
Alfieri, Ottavio
中科院分区：
文献类型：
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作者：
Agricola, Eustachio;Oppizzi, Michele;Alfieri, Ottavio
虽然缺血性二尖瓣返流（MR）的机制已被了解，但缺血性MR的超声心动图图像并不均匀。根据栓系模式，将92例因活动受限导致慢性缺血性MR的连续患者分为两组：两个瓣叶主要后部栓系的不对称组（54例患者）和两个瓣叶主要顶部栓系的对称组（38例患者）。评价二尖瓣变形指数、左室整体（体积、功能和球形度）和局部（乳头肌位移和局部室壁运动评分指数）重构。对称组左室整体重构的所有指标均显著高于不对称组（均p < 0.0001），如前乳头肌的后移和侧向位移（均p < 0.04）、乳头肌分离和前乳头肌室壁运动指数（均p < 0.0001）。在对称组的所有患者中，射流的起源和方向都是中心的。在不对称型中，78%的病例起源于中央，22%的病例起源于内侧连合，而83%的患者和17%的患者的射流方向分别为后方和中央。因此，根据系留模式、不同程度的局部和整体LV重塑以及反流束特征，可以区分至少两个亚组的活动受限所致缺血性MR患者。
Although the mechanism of ischemic mitral regurgitation (MR) is understood, the echocardiographic picture of ischemic MR is not homogeneous. Ninety-two consecutive patients with chronic ischemic MR due to restricted motion were divided into two groups according to tethering pattern: the asymmetric group with predominant posterior tethering of both leaflets (54 patients) and the symmetric one with predominant apical tethering of both leaflets (38 patients). The mitral deformation indexes, LV global (volume, function and sphericity) and local (papillary muscle displacements and regional wall motion score index) remodeling were evaluated. All indexes of global LV remodeling were significantly higher in the symmetric than asymmetric group (all p < 0.0001), such as the posterior and lateral displacement of the anterior papillary muscle (both p < 0.04), the papillary muscle separation and the anterior papillary muscle wall motion index (both p < 0.0001). The origin as well as the direction of the jet was central in all patients of the symmetric group. In the asymmetric one the origin was central in 78% of the cases and arising from the medial commissure in 22% whereas the jet direction was posterior and central in 83% and 17% of patients, respectively. Therefore, it is possible to distinguish at least two subgroups of patients with ischemic MR due to restricted motion on the basis of tethering pattern, different degree of local and global LV remodeling and characteristics of the regurgitant jet.