Mechanism of atrial functional mitral regurgitation in patients with atrial fibrillation: A study using three-dimensional transesophageal echocardiography
Mechanism of atrial functional mitral regurgitation in patients with atrial fibrillation: A study using three-dimensional transesophageal echocardiography
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DOI：
10.1016/j.jjcc.2017.03.013
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发表时间：
2017-11-01
影响因子：
2.5
通讯作者：
Yoshikawa, Junichi
中科院分区：
文献类型：
--
作者：
Ito, Kazato;Abe, Yukio;Yoshikawa, Junichi
背景资料：功能性二尖瓣返流（MR）可能发生在房颤（AF）患者中，尽管左心室（LV）收缩功能保留。本研究的目的是利用实时三维经食管超声心动图（3DTEE）来阐明心房功能性MR的机制。方法：60例患者接受了经胸超声心动图和3DTEE：AF-MR组16例，房颤伴明显非器质性MR，左室射血分数保留（>50%），将20例无明显二尖瓣返流的房颤患者作为房颤非小二尖瓣返流组，24例正常人作为对照组。AF-MR组的左心房容积指数明显大于对照组（95 +/- 41 ml/m2）比AF-NSMR组（38 +/- 13 ml/m2，p < 0.05）或对照组（21 +/- 7 ml/m2，p < 0.05）。AF-MR组的3D瓣环周长显著长于AF-NSMR组。AF-MR组的瓣环-前叶接合角小于AF-NSMR组（11 +/- 6度vs. 18 +/- 9度，p < 0.05）。两个AF组之间的瓣环-后叶接合角相当（26 +/- 12度vs. 28 +/- 10度），而AF-MR组的瓣环-后叶尖端角大于AF-NSMR组（59 +/- 13度vs. 44 +/- 11度，p <0. 05）。因此，AF-MR组后叶向LV腔的弯曲明显大于AF-NSMR组（32 +/- 10度vs. 18 +/- 15度，p < 0.05）。在房颤和显著功能性二尖瓣返流（尽管LV收缩功能保留）患者中，左心房和二尖瓣环扩张，前叶沿着二尖瓣环平面变平，而后叶向LV腔弯曲。(C)2017年日本心脏病学院。由爱思唯尔有限公司出版。保留所有权利。
Background: Functional mitral regurgitation (MR) can occur in patients with atrial fibrillation (AF) despite having preserved left ventricular (LV) systolic function. This MR is known as atrial functional MR. The aim of this study was to clarify the mechanism of atrial functional MR using real-time three-dimensional transesophageal echocardiography (3DTEE).Methods: Sixty patients underwent transthoracic echocardiography and 3DTEE: 16 patients with AF and significant non-organic MR and preserved LV ejection fraction (>50%) constituted the AF-MR group, 20 patients with AF and no significant MR formed the AF-NSMR group, and 24 normal subjects comprised the control group.Results: The left atrial volume index was significantly larger in the AF-MR group (95 +/- 41 ml/m(2)) than in the AF-NSMR group (38 +/- 13 ml/m(2), p < 0.05) or the control group (21 +/- 7 ml/m(2), p < 0.05). The 3D annular circumference was significantly longer in the AF-MR group than in the AF-NSMR group. The annular-anterior leaflet coaptation angle was smaller in the AF-MR group than in the AF-NSMR group (11 +/- 6 degrees vs. 18 +/- 9 degrees, p < 0.05). The annular-posterior leaflet coaptation angle was comparable between the two AF groups (26 +/- 12 degrees vs. 28 +/- 10 degrees), whereas the annular-posterior leaflet tip angle was larger in the AF-MR group than in the AF-NSMR group (59 +/- 13 degrees vs. 44 +/- 11 degrees, p < 0.05). The posterior leaflet bending toward LV cavity was therefore significantly larger in the AF-MR group than in the AF-NSMR group (32 +/- 10 degrees vs. 18 +/- 15 degrees, p < 0.05).Conclusions: In patients with AF and significant functional MR occurring despite their preserved LV systolic function, the left atrium and mitral annulus were dilated and the anterior leaflet was flattened along the mitral annular plane, whereas the posterior leaflet was bent toward the LV cavity. (C) 2017 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.