Valve Strain Quantitation in Normal Mitral Valves and Mitral Prolapse With Variable Degrees of Regurgitation
Valve Strain Quantitation in Normal Mitral Valves and Mitral Prolapse With Variable Degrees of Regurgitation
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DOI：
10.1016/j.jcmg.2021.01.006
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发表时间：
2021-06-01
影响因子：
14
通讯作者：
Zoghbi, William A.
中科院分区：
文献类型：
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作者：
El-Tallawi, K. Carlos;Zhang, Peng;Zoghbi, William A.
本研究的目的是定量患者特异性二尖瓣（MV）应变在正常瓣膜和二尖瓣脱垂的患者，并没有显着的二尖瓣返流（MR）和评估MV strain.Background的决定因素MV变形在人类心脏收缩期间存在的数据很少。三维超声心动图允许动态MV成像，使MV功能在健康和diseases.METHODS的数字化建模进行了82例，32例正常MV和50二尖瓣脱垂（MVP）：12轻度二尖瓣返流或更少（MVP - MR）和38中度二尖瓣返流或更大（MVP + MR）。结果各组大鼠左室射血分数均正常。MVP + MR的二尖瓣环尺寸最大（瓣环面积：13.8 +/- 0.7 cm（2）），MVP - MR（10.6 +/- 1 cm（2））和正常瓣膜（10.5 +/- 0.3 cm（2）;方差分析：p < 0.001）具有可比性。同样，MVP + MR的MV瓣叶面积最大，尤其是后叶（8.7 +/- 0.5 cm（2））; MVP -MR居中（6.5 +/- 0.7 cm（2））;正常瓣膜最小（5.5 +/- 0.2 cm（2）; p < 0.0001）。MVP + MR的应变总体最高，正常瓣膜的应变最低。MVP -MR患者的后叶应变值高于正常瓣膜（p = 0.001）。在多变量分析中，调整临床和MV几何参数后，瓣叶厚度是唯一保留的参数，与平均MV应变显著相关（r = 0.34; p = 0.008）。结论与正常瓣膜相比，表现出脱垂的MV具有更高的应变，特别是在后叶。尽管二尖瓣返流恶化和瓣膜及瓣环较大时观察到应变较高，但二尖瓣瓣叶厚度-以及潜在MV病理学-是瓣膜变形的最重要独立决定因素。需要进一步研究来评估MV应变测定对临床结局的影响。(C)2021年由美国心脏病学会基金会。
OBJECTIVES The aim of this study was to quantitate patient-specific mitral valve (MV) strain in normal valves and in patients with mitral valve prolapse with and without significant mitral regurgitation (MR) and assess the determinants of MV strain.BACKGROUND Few data exist on MV deformation during systole in humans. Three-dimensional echocardiography allows for dynamic MV imaging, enabling digital modeling of MV function in health and disease.METHODS Three-dimensional transesophageal echocardiography was performed in 82 patients, 32 with normal MV and 50 with mitral valve prolapse (MVP): 12 with mild mitral regurgitation or less (MVP - MR) and 38 with moderate MR or greater (MVP + MR). Three-dimensional MV models were generated, and the peak systolic strain of MV leaflets was computed on proprietary software.RESULTS Left ventricular ejection fraction was normal in all groups. MV annular dimensions were largest in MVP + MR (annular area: 13.8 +/- 0.7 cm(2)) and comparable in MVP - MR (10.6 +/- 1 cm(2)) and normal valves (10.5 +/- 0.3 cm(2); analysis of variance: p < 0.001). Similarly, MV leaflet areas were largest in MVP + MR, particularly the posterior leaflet (8.7 +/- 0.5 cm(2)); intermediate in MVP -MR (6.5 +/- 0.7 cm(2)); and smallest in normal valves (5.5 +/- 0.2 cm(2); p < 0.0001). Strain was overall highest in MVP + MR and lowest in normal valves. Patients with MVP -MR had intermediate strain values that were higher than normal valves in the posterior leaflet (p = 0.001). On multivariable analysis, after adjustment for clinical and MV geometric parameters, leaflet thickness was the only parameter that was retained as being significantly correlated with mean MV strain (r = 0.34; p = 0.008).CONCLUSIONS MVs that exhibit prolapse have higher strain compared to normal valves, particularly in the posterior leaflet. Although higher strain is observed with worsening MR and larger valves and annuli, mitral valve leaflet thickness- and, thus, underlying MV pathology- is the most significant independent determinant of valve deformation. Future studies are needed to assess the impact of MV strain determination on clinical outcome. (C) 2021 by the American College of Cardiology Foundation.