Leaflet concavity: A rapid visual clue to the presence and mechanism of functional mitral regurgitation
Leaflet concavity: A rapid visual clue to the presence and mechanism of functional mitral regurgitation
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DOI：
10.1067/j.echo.2003.09.003
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发表时间：
2003-12-01
影响因子：
6.5
通讯作者：
Hung, J
中科院分区：
文献类型：
--
作者：
Nesta, F;Otsuji, Y;Hung, J
修复二尖瓣返流（MR）需要了解其机制。在功能性二尖瓣返流中评价瓣叶限制性闭合具有挑战性。长轴（LAX）视图中瓣叶和瓣环之间的帐篷区与MR相关，但即使在对照受试者中也呈阳性;在四腔视图中，二尖瓣瓣叶不完全关闭（IMLC）帐篷模式可能很微妙且可变。我们检验了LAX视图中瓣叶朝向左心房的假设，这是一个快速的视觉线索，表明主要由中间腱索引起的异常栓系，是功能性MR的一个强有力的指标。我们回顾了90例患者：40例下壁心肌梗死和射血分数大于或等于50%; 40例左心室功能不全和射血分数< 50%; 10例对照受试者。我们评估了LAX视图中的瓣叶、形状（向左心房凹或凸）和最大收缩期近端MR射流宽度。为了量化形状，我们测量了前叶和连接其两端的线之间的瓣叶面积。还评估了常规IMLC面积。瓣叶扩张患者的二尖瓣返流明显大于无瓣叶扩张的患者（射流宽度为4.6 +/- 0.7 vs 0.5 +/- 0.1 mm，P <0.0001），表明轻度-中度与轻度二尖瓣返流，下壁心肌梗死和左心室功能不全患者的差异相当。通过多变量回归（R-2 = 0.7），瓣叶扩张面积最强预测MR。常规IMLC面积不能唯一区分有或无MR的患者，与MR的相关性更弱（R-2 = 0.30 vs 0.73）。LAX视图中的二尖瓣瓣叶扩张可快速可靠地识别功能性二尖瓣返流，其可靠性高于IMLC区域。这种形状与中间和弦的束缚一致，可能对潜在的干预有影响。
Repairing mitral regurgitation (MR) requires an understanding of its mechanism. Evaluating restricted leaflet closure in functional MR is challenging. Tenting area between leaflets and annulus in long-axis (LAX) views correlates with MR, but is positive even in control subjects; in the 4-chamber view, the incomplete mitral leaflet closure (IMLC) tenting pattern may be subtle and variable. We tested the hypothesis that leaflet concavity toward the left atrium in the LAX view, a rapid visual clue indicating abnormal tethering predominantly by intermediate chords, is a strong indicator of functional MR. We reviewed 90 patients:.40- with inferior myocardial infarction and ejection fraction greater than or equal to 50%; 40 with global left ventricular dysfunction and ejection fraction < 50%; and 10 control subjects. We assessed leaflet, shape (concave or convex toward the left atrium) and maximum systolic proximal MR jet width in the LAX views. To quantify shape, we measured the leaflet concavity area between the anterior leaflet and a line connecting its ends. Conventional IMLC area was also assessed. Patients with leaflet concavity had significantly greater MR than those without this finding (jet width of 4.6 +/- 0.7 vs 0.5 +/- 0.1 mm, P < .0001), indicating mild-moderate versus trace MR, with differences comparable in those with inferior myocardial infarction and left ventricular dysfunction. Leaflet concavity area most strongly predicted MR by multivariate regression (R-2 = 0.7). Conventional IMLC area did not uniquely distinguish patients with or without MR and correlated more weakly with MR (R-2 = 0.30 vs 0.73). Mitral leaflet concavity in the LAX view provides rapid and reliable recognition of functional MR, with greater reliability than IMLC area. This shape, consistent with tethering by intermediate chords, may have implications for potential intervention.