The role of ischemic mitral regurgitation in the pathogenesis of acute pulmonary edema
The role of ischemic mitral regurgitation in the pathogenesis of acute pulmonary edema
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DOI：
10.1056/nejmoa040532
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发表时间：
2004-10-14
影响因子：
158.5
通讯作者：
Lancellotti, P
中科院分区：
文献类型：
--
作者：
Pierard, LA;Lancellotti, P
背景：急性二尖瓣反流可能导致肺水肿，但慢性缺血性二尖瓣反流的发病作用，一个动态的条件，尚未characteristic.METHODS：我们前瞻性研究了28例（平均[+/-SD]年龄，65+/-11岁）急性肺水肿和左心室收缩功能障碍和46例无急性肺水肿病史的患者。两组的所有基线特征都匹配。患者在运动期间接受定量多普勒超声心动图检查。在有和没有急性肺水肿的患者中，比较了心绞痛引起的左心室容积、射血分数、二尖瓣返流容积、有效返流口面积和经二尖瓣压力梯度的变化。他们在心率、收缩压和左心室容积方面也有类似的运动引起的变化。在单变量分析中，近期有肺水肿的患者二尖瓣返流量的增加远高于无肺水肿的患者（26+/-14 ml vs. 5+/-14 ml，P
BACKGROUND:Acute mitral regurgitation may cause pulmonary edema, but the pathogenetic role of chronic ischemic mitral regurgitation, a dynamic condition, has not yet been characterized.METHODS:We prospectively studied 28 patients (mean [+/-SD] age, 65+/-11 years) with acute pulmonary edema and left ventricular systolic dysfunction and 46 patients without a history of acute pulmonary edema. The two groups were matched for all baseline characteristics. Patients underwent quantitative Doppler echocardiography during exercise. Exercise-induced changes in the left ventricular volume, the ejection fraction, the mitral regurgitant volume, the effective regurgitant orifice area, and the transtricuspid pressure gradient were compared in patients with and without acute pulmonary edema.RESULTS:The two groups had similar clinical and baseline echocardiographic characteristics. They also had similar exercise-induced changes in heart rate, systolic blood pressure, and left ventricular volumes. In the univariate analysis, patients with recent pulmonary edema had a much higher increase than did the patients without pulmonary edema in mitral regurgitant volume (26+/-14 ml vs. 5+/-14 ml, P