Significance of systolic anterior motion of the mitral valve during dobutamine stress echocardiography
Significance of systolic anterior motion of the mitral valve during dobutamine stress echocardiography
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DOI：
10.1016/j.echo.2004.08.018
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发表时间：
2005-01-01
影响因子：
6.5
通讯作者：
Tribouilloy, C
中科院分区：
文献类型：
--
作者：
Meimoun, P;Benali, T;Tribouilloy, C
多巴酚丁胺负荷超声心动图(DSE)引起的起始瓣收缩期前运动(SAM)引起的左室流出道梗阻并不少见，但其意义尚不明确。共有100名连续的患者(平均年龄62岁+/-12岁，其中67%为男性)既往无跨壁心肌梗死、瓣膜病或肥厚型心肌病病史，接受DSE以评估是否存在心肌缺血。搜索有DSE的SAM，并将其与临床和基线超声心动图结果相关联。选择表现为SAM合并DSE的患者，在DSE后6个月内进行自行车运动超声心动图多普勒检查。DSE或运动导致的脑室内梯度的发展被定义为大于或等于36毫米汞柱的新的梯度。总共有23例患者在DSE期间发生SAM，平均梯度为79+/-33 mm Hg(范围：39-144 mm Hg)和与SAM相关的二尖瓣关闭不全。与无SAM的患者相比，合并DSE的SAM患者在静息状态下的特点是二尖瓣夹角和隔主动脉夹角较小，二尖瓣后叶长度较长，左室腔较小。DSE期间的缺血或低血压反应均与SAM无关。在SAM患者组中，在9名因不明原因胸痛或呼吸困难而转诊的患者中，有5名患者出现DSE症状，而在17名非SAM患者中有2名出现症状(P=0.005)。尽管有这些发现，与DSE相比，接受运动超声心动图多普勒检查的16名患者中只有3人发生了SAM(两人有症状)，获得的心率范围很大。虽然SAM合并DSE的患者表现出易患的超声心动图结果，但这种现象的临床影响仅在少数患者中真实存在，特别是那些经历不明原因的呼吸困难或胸痛的患者。
Left ventricular outflow tract obstruction related to systolic anterior motion of the initial valve (SAM) induced during dobutamine stress echocardiography (DSE) is not unusual but its significance is not established. A total of 100 consecutive patients (mean age 62 +/- 12 years; 67% male) without previous transmural myocardial infarction, valvular disease, or hypertrophic cardiomyopathy, undergoing DSE to assess the presence of myocardial ischemia, were prospectively evaluated. A SAM with DSE was searched and correlated with clinical and baseline echocardiographic findings. Patients who demonstrated SAM with DSE were selected for exercise echocardiographic Doppler study with bicycle, within 6 months of the DSE. The development of an intraventricular gradient with DSE or exercise was defined as a new gradient of greater than or equal to36 mm Hg. In all, 23 patients developed SAM during DSE with a mean gradient of 79 +/- 33 mm Hg (range: 39-144 mm Hg) and mitral regurgitation related to SAM. Compared with patients without SAM, patients who developed SAM with DSE were characterized at rest by a smaller mitroaortic angle and septoaortic angle, a higher posterior mitral leaflet length, and a smaller left ventricular cavity. Neither ischemic nor hypotensive response during DSE were correlated to SAM. In the group of patients with SAM., of the 9 patients who were referred for unexplained chest pain or dyspnea, 5 reproduced symptoms with DSE, compared with 2 of 17 patients in the group without SAM (P = .005). Despite these findings, only 3 of the 16 patients who underwent exercise echocardiography Doppler study developed SAM (two with symptoms), with a wide range of achieved heart rate, compared with DSE. Although patients with SAM with DSE exhibit predisposing echocardiographic findings, the clinical impact of this phenomenon is real in only a minority of patients, particularly those who experienced unexplained dyspnea or chest pain.