Changes in mitral annular geometry and dynamics with ß-blockade in patients with degenerative mitral valve disease.
Changes in mitral annular geometry and dynamics with ß-blockade in patients with degenerative mitral valve disease.
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DOI：
10.1161/circimaging.110.959171
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发表时间：
2010-11
期刊：
影响因子：
--
通讯作者：
Stewart RA
中科院分区：
文献类型：
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作者：
Ennis DB;Rudd-Barnard GR;Li B;Fonseca CG;Young AA;Cowan BR;Stewart RA
二尖瓣环重构可能有助于二尖瓣返流(MR)的进展。在中到重度二尖瓣反流的患者中，β阻滞剂的短期治疗被证明增加了左室舒张末和收缩末容量，这可能有害地增加二尖瓣环的内径。本研究的目的是量化β阻滞剂短期治疗对原发性退行性瓣膜病所致二尖瓣关闭不全患者二尖瓣环大小和动力学的影响。对2 5例中、重度退行性MR患者进行双盲交叉试验，用β1受体阻滞剂和安慰剂治疗14±3d。在每个治疗周期后采集心脏磁共振图像以量化二尖瓣环的大小。舒张末(ED)环面积(1659±331vs1632±299mm2，P<；0.19)、环周径(154.3±16.4vs152±13.9 mm，P<；0.13)、间隔-侧径(38.0±5mmvs39.0±4.5 mm，P<；0.15)、环高度(9.8±3.8vs9.5±2.5 mm，P<；0.53)无明显变化。β受体阻滞剂阻断后，ED的连合-连合内径(48.9±4.6 mm比47.2±4.0 mm，P<0.01)和偏心度(1.3±0.2vs 1.2±0.1P<；0.01)明显减小。在收缩末期(ES)，B受体阻滞剂使瓣环周长(161.0±19.3vs 156.8±16.9 mm，P<；0.04)和偏心度(1.2±0.1vs 1.1±0.1P<；0.02)显著减小，SL内径显著增加(41.5±5.7vs 43.0±5.3 mm，P<；0.03)。Es处的CC、环状面积和环状高度无显著差异。尽管左心室收缩末容量和左心室收缩末期容量显著增加，β阻滞剂对中度到重度二尖瓣反流患者的短期治疗减少或保留了除ES处SL外的所有二尖瓣环的大小。
Remodeling of the mitral annulus may contribute to progression of mitral regurgitation (MR). In patients with moderate to severe mitral regurgitation short term treatment with a β-blockers has been shown to increase left ventricular end diastolic and end systolic volume and this could deleteriously increase mitral valve annular dimensions. The objective of this study was to quantify the effects of a short duration of β-blocker treatment on mitral annular dimensions and dynamics in patients with mitral regurgitation due to primary degenerative valve disease. Twenty-five patients with moderate to severe degenerative MR and normal left ventricular systolic function were studied in a double blind crossover experiment using a β1-selective adrenergic blocker and placebo administered for 14±3days. Cardiac magnetic resonance images were acquired after each treatment period to quantify mitral annular dimensions. At end diastole (ED) there was no change in annular area (1659±331 vs 1632±299mm2, P<0.19), annular perimeter (154.3±16.4 vs 152±13.9mm, P<0.13), septal-lateral dimension(38.0±5mm vs 39.0±4.5mm, P<0.15), nor annular height (9.8±3.8 vs 9.5±2.5mm, P<0.53). β-blockade resulted in significant ED decreases in commissure-commissure (CC) dimension (48.9 ± 4.6mm vs 47.2 ± 4.0mm P<0.01) and eccentricity (1.3 ± 0.2 vs 1.2 ± 0.1 P<0.01). At end systole (ES), ß-blockade conferred a small, but significant decrease in annular perimeter (161.0±19.3 vs 156.8±16.9mm, P<0.04) and eccentricity (1.2±0.1 vs 1.1±0.1 P<0.02) and the SL dimension significantly increased (41.5±5.7 vs 43.0±5.3mm, P<0.03). CC, annular area, and annular height at ES were not significantly different. Despite significant increases in LVEDV and LVESV, short-term β-blocker treatment of patients with moderate to severe mitral regurgitation reduced or preserved all mitral annular dimensions, except SL at ES.