Prevalence, distribution, and determinants of pulmonary venous systolic flow reversal in severe mitral regurgitation
Prevalence, distribution, and determinants of pulmonary venous systolic flow reversal in severe mitral regurgitation
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严重二尖瓣反流中肺静脉收缩期血流逆转的发生率、分布和决定因素
DOI：
10.1093/ehjci/jeab098
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发表时间：
2021
期刊：
影响因子：
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通讯作者：
Nakano Yukiko
中科院分区：
文献类型：
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作者：
Itakura Kiho;Utsunomiya Hiroto;Takemoto Hajime;Takahari Kosuke;Ueda Yusuke;Izumi Kanako;Ikenaga Hiroki;Hidaka Takayuki;Fukuda Yukihiro;Nakano Yukiko
目的探讨重度二尖瓣反流(MR)患者肺静脉收缩期血流反转(PVSFR)的发生率、分布及其与心脏参数的关系。方法与结果对125例接受经食道超声心动图(TOE)检查的重度MR患者进行分析。其中121例(96.8%)患者的四支肺静脉(PV)均显示为足趾血流。根据MR病因学将其分为三组：退行性MR( )72例，室功能MR(V-FMR)20例，心房功能MR(A-FMR)(n= 16)。18例(16.7%)患者均有PVSFR。29例(26.9%)出现PVSFR，其中23例(21.3%)出现在2条PVS中，23例(21.3%)出现在1条PVS中。PVSFR出现在右室较左室多。PVSFR数目的增加与肺毛细血管楔压(PCWP)和3D-VCA显著相关。在MR病因学方面，在DMR和A-FMR患者中，PVSFRs数量与高3D-VCA相关，而在V-FMR患者中，PVSFR数量与高PCWP相关。层状型PVSFR在FMR组较DMR组多见，并与较高的PCWP和较低的右室面积变化(RVFAC)有关。结论四种PVR的检出率均为96.8%，其中16.8%的患者存在PVSFR。重度MR患者的PCWP和3D-VCA与PVSFRs数目相关。层流型PVSFR与较高的PCWP和较低的RVFAC有关。
AimsThis study aimed to evaluate the prevalence and distribution of pulmonary venous systolic flow reversal (PVSFR) in patients with severe mitral regurgitation (MR), and to examine the relationship between PVSFR profile and cardiac parameters.Methods and resultsA total of 125 patients with severe MR who had transoesophageal echocardiography (TOE) performed were reviewed. Of these, 121 (96.8%) patients showed all four pulmonary venous (PV) flows by TOE. They were categorized into three groups by the MR aetiology: degenerative MR (DMR) (n= 72), ventricular functional MR (V-FMR) (n= 20), and atrial functional MR (A-FMR) (n= 16). Eighteen (16.7%) patients had PVSFR in all four PVs. Twenty-nine (26.9%) had PVSFR in three PVs, 23 (21.3%) in two PVs, and 23 (21.3%) in one PV. PVSFR appeared at right PVs more frequently compared with left PVs. A high number of PVSFR was significantly correlated with higher pulmonary capillary wedge pressure (PCWP) and 3D vena contracta area (3D-VCA). With regard to MR aetiology, the number of PVSFRs was correlated with high 3D-VCA in patients with DMR and A-FMR, while it was correlated with high PCWP in patients with V-FMR. Laminar-type PVSFR appeared more frequently in FMR compared with DMR, and it had a relationship with higher PCWP and lower right ventricular fractional area change (RVFAC).ConclusionAll four PV were detected in 96.8%, and 16.8% patients had PVSFR in all four PVs. PCWP and 3D-VCA were correlated with the number of PVSFRs in severe MR patients. Laminar-type PVSFR was related to higher PCWP and lower RVFAC.