Usefulness of Mitral Regurgitant Volume Quantified Using Magnetic Resonance Imaging to Predict Left Ventricular Remodeling After Mitral Valve "Correction".
Usefulness of Mitral Regurgitant Volume Quantified Using Magnetic Resonance Imaging to Predict Left Ventricular Remodeling After Mitral Valve "Correction".
复制标题
使用磁共振成像量化二尖瓣反流体积以预测二尖瓣“校正”后左心室重塑的有用性。
DOI：
10.1016/j.amjcard.2020.02.045
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发表时间：
2020
期刊：
影响因子：
--
通讯作者：
Wolff,StevenD
中科院分区：
文献类型：
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作者：
Uretsky,Seth;Shah,DipanJ;Lasam,Glenmore;Horgan,Stephen;Debs,Dany;Wolff,StevenD
MRI研究显示，原发性慢性二尖瓣返流（MR）患者的二尖瓣返流容积与左心室舒张末期容积（LV EDV）之间存在密切相关性。他们还显示了二尖瓣手术后的抗心律失常剂量与LVEDV降低之间的密切相关性。本研究的目的是验证一种经验计算方法，该方法可用于术前预测二尖瓣修复术后左心室重构的程度。这是一项前瞻性多中心研究，纳入了63例（61 ± 13岁，男性65%）在二尖瓣矫正前后接受MRI的患者。对二尖瓣矫正前后的心室容积和射血分数进行量化。LV EDV的预测变化根据经验计算为二尖瓣返流容积/左心室射血分数。将观察到的LV EDV变化与LV EDV的预测变化进行比较。61例（97%）患者在二尖瓣矫正术后LVEDV降低（237 ± 66 ml vs 164 ± 46 ml，p <0.0001）。整个队列中观察到的LVEDV变化与预测值之间的相关性良好（r = 0.77，p <0.0001），残留二尖瓣返流<10 ml的患者相关性极佳（r = 0.87，p <0.0001）。这种紧密相关性见于原发性MR（0.86，p <0.0001）和继发性MR（0.97，p <0.0001）以及残余MR <10 ml的患者。左室重构的多变量预测因子是MR体积、原发性MR和LVESV。总之，心脏MRI容积测量可准确预测二尖瓣矫正后的LV重构。这一发现支持了MRI可准确量化慢性二尖瓣返流严重程度的观点，并且在二尖瓣矫正术前应强烈考虑进行心脏MRI。
MRI studies have shown a tight correlation between mitral regurgitant volume and left ventricular end-diastolic volume (LV EDV) in patients with primary chronic mitral regurgitation (MR). They have also shown a tight correlation between regurgitant volume and the decrease in LVEDV following mitral valve surgery. The purpose of this study is to validate an empiric calculation that can be used preoperatively to predict the amount of left ventricular remodeling following mitral valve correction. This is a prospective multicenter study of 63 (61 ± 13 years, male 65%) patients who underwent an MRI before and after mitral valve correction. Pre and postmitral valve correction ventricular volumes and ejection fractions were quantified. The predicted change in LV EDV was empirically calculated as mitral regurgitant volume/left ventricular ejection fraction. The observed change in LV EDV was compared to the predicted change in LV EDV. The LVEDV decreased in 61 (97%) patients following mitral valve correction (237 ± 66 ml vs 164 ± 46 ml, p <0.0001). Correlation between the observed and predicted change in LVEDV was good for the entire cohort (r = 0.77, p <0.0001) and excellent in patients with <10 ml of residual MR (r = 0.87, p <0.0001). This tight correlation was seen in both patients with primary (0.86, p <0.0001) and secondary MR (0.97, p <0.0001) and <10 ml of residual MR. Multivariate predictors of LV remodeling were MR volume, primary MR, and LVESV. In conclusion cardiac MRI volumetric measurements accurately predict LV remodeling following mitral valve correction. This finding supports the notion that MRI accurately quantifies the severity of chronic mitral regurgitation and a cardiac MRI should be strongly considered before mitral valve correction.