Two cases showing alterations of the order of tricuspid and mitral valve opening during loading manipulations: a new approach for quick assessment of stress-induced left ventricular filling pressure elevation
Two cases showing alterations of the order of tricuspid and mitral valve opening during loading manipulations: a new approach for quick assessment of stress-induced left ventricular filling pressure elevation
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DOI：
10.1007/s10396-022-01224-4
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发表时间：
2022-05-30
影响因子：
1.8
通讯作者：
Anzai，Toshihisa
中科院分区：
文献类型：
--
作者：
Murayama，Michito;Iwano，Hiroyuki;Anzai，Toshihisa
讨论 左心室舒张期储备受损是心力衰竭的一个隐匿症状，也是其不良后果的预测因素[1]。虽然在正常情况下，TV舒张早期打开先于MV打开，但一旦左心房（LA）压力升高，由于LA和LV压力早期交叉，MV打开变得提前并先于TV打开[2,3,4]。病例1中，运动时E/e'随PCWP升高而增加，AVV打开顺序也发生改变。同时，在情况 2 中，E/e' 没有跟踪抬腿期间 PCWP 的增加，但 AVV 的顺序正确改变。由于 E 速度取决于舒张早期 LA 与 LV 压力差 [5]，因此尽管 LA v 波增加，但由于 LV 最小压力增加，E 速度的增加可能是温和的。这些病例强调了应激引起的舒张早期 AVV 打开顺序的改变对于检测左心室舒张功能储备受损的潜在有用性。然而，需要进一步的研究，包括更大的样本，最好使用同步导管插入超声心动图测试，以证实我们的发现。
DiscussionImpaired LV diastolic reserve is an occult sign of heart failure and a predictor of its adverse outcomes [1]. While the early-diastolic opening of TV precedes that of MV under normal conditions, once left atrial (LA) pressure elevates, the opening of MV becomes early and precedes TV opening resulting from the early crossover of LA and LV pressures [2, 3, 4]. In case 1, E/e′ increased along with the elevated PCWP during exercise, and the order of AVV opening was also altered. Meanwhile, in case 2, E/e′ did not track the increase of PCWP during leg lifts, but the order of AVV correctly changed. Because E velocity depends on the early-diastolic LA to LV pressure difference [5], the increase in E velocity might have been gentle due to the increase of LV minimal pressure despite the increased LA v-wave. These cases underline the potential usefulness of the stress-induced alteration of the order of early-diastolic AVV opening to detect impaired LV diastolic function reserve. However, further studies including a larger sample, ideally using simultaneous catheterization-echocardiographic testing, are needed to confirm our findings.