Mitral Valve Remodeling and Strain in Secondary Mitral Regurgitation
Mitral Valve Remodeling and Strain in Secondary Mitral Regurgitation
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继发性二尖瓣反流中的二尖瓣重塑和应变
DOI：
10.1016/j.jcmg.2021.02.004
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发表时间：
2021
期刊：
影响因子：
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通讯作者：
Zoghbi, William A.
中科院分区：
文献类型：
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作者：
El-Tallawi, K. Carlos;Zhang, Peng;Azencott, Robert;He, Jiwen;Xu, Jiaqiong;Herrera, Elizabeth L.;Jacob, Jessen;Chamsi-Pasha, Mohammed;Lawrie, Gerald M.;Zoghbi, William A.
ObjectivesThe的目的，这项研究是评估二尖瓣（MV）的重塑和应变与原发性二尖瓣返流（PMR）和正常valves.BackgroundA缺乏的数据存在于二尖瓣应变在人类心动周期的患者相比，继发性二尖瓣返流（SMR）。实时三维（3D）超声心动图允许动态MV成像，使计算机模拟的MV功能在正常和疾病states.MethodsThree-dimensional经食管超声心动图（TEE）进行了总共106名受试者：36与SMR，38与PMR，和32与正常的阀门; MR严重程度至少是中度的MR组。定量瓣膜几何参数，并使用专用软件在收缩期生成患者特异性3D MV模型。整体和区域峰值收缩期MV应变计算使用专有software.ResultsMV环面积较大的SMR和PMR组（12.7 ± 0.7和13.3 ± 0.7 cm 2，分别）与正常人（9.9 ± 0.3 cm 2; p < 0.05）相比。瓣叶也有显著重塑，SMR（16.2 ± 0.9 cm 2）和PMR（15.6 ± 0.8 cm 2）的总MV瓣叶面积大于正常受试者（11.6 ± 0.4 cm 2）。SMR中的瓣叶比正常受试者的瓣叶厚，但略小于PMR后部的瓣叶。在所有3组中，后叶应变显著高于前叶应变。尽管二尖瓣重塑，SMR的应变（8.8 ± 0.3%）总体上与正常受试者（8.5 ± 0.2%）相似，且均低于PMR（12 ± 0.4%; p < 0.0001）。瓣膜厚度、二尖瓣返流严重程度和二尖瓣返流的主要病因与应变相关，瓣叶厚度是与MV应变显著相关的多变量参数。在不太严重的MR患者，前叶应变SMR低于正常，而应变PMR仍然高于normal.ConclusionsThe MV在继发性MR remodels显着和类似的PMR与由此产生的较大的环形面积，瓣叶表面积，瓣叶厚度与正常人相比。尽管有这些变化，MV应变仍然接近或在某些情况下低于正常，并显着低于PMR。应变测定有可能改善人类二尖瓣机械生物学特性的表征，并评价其对二尖瓣返流患者（有或无瓣膜介入）的预后影响。
ObjectivesThe aim of this study was to assess mitral valve (MV) remodeling and strain in patients with secondary mitral regurgitation (SMR) compared with primary MR (PMR) and normal valves.BackgroundA paucity of data exists on MV strain during the cardiac cycle in humans. Real-time 3-dimensional (3D) echocardiography allows for dynamic MV imaging, enabling computerized modeling of MV function in normal and disease states.MethodsThree-dimensional transesophageal echocardiography (TEE) was performed in a total of 106 subjects: 36 with SMR, 38 with PMR, and 32 with normal valves; MR severity was at least moderate in both MR groups. Valve geometric parameters were quantitated and patient-specific 3D MV models generated in systole using a dedicated software. Global and regional peak systolic MV strain was computed using a proprietary software.ResultsMV annular area was larger in both the SMR and PMR groups (12.7 ± 0.7 and 13.3 ± 0.7 cm2, respectively) compared with normal subjects (9.9 ± 0.3 cm2; p < 0.05). The leaflets also had significant remodeling, with total MV leaflet area larger in both SMR (16.2 ± 0.9 cm2) and PMR (15.6 ± 0.8 cm2) versus normal subjects (11.6 ± 0.4 cm2). Leaflets in SMR were thicker than those in normal subjects but slightly less than those with PMR posteriorly. Posterior leaflet strain was significantly higher than anterior leaflet strain in all 3 groups. Despite MV remodeling, strain in SMR (8.8 ± 0.3%) was overall similar to normal subjects (8.5 ± 0.2%), and both were lower than in PMR (12 ± 0.4%; p < 0.0001). Valve thickness, severity of MR, and primary etiology of MR were correlates of strain, with leaflet thickness being the multivariable parameter significantly associated with MV strain. In patients with less severe MR, anterior leaflet strain in SMR was lower than normal, whereas strain in PMR remained higher than normal.ConclusionsThe MV in secondary MR remodels significantly and similarly to PMR with a resultant larger annular area, leaflet surface area, and leaflet thickness compared with that of normal subjects. Despite these changes, MV strain remains close to or in some instances lower than normal and is significantly lower than that of PMR. Strain determination has the potential to improve characterization of MV mechano-biologic properties in humans and to evaluate its prognostic impact in patients with MR, with or without valve interventions.