M.Y. Kallala, N. Bouchehda, S. Lamine, S. Kraeim, M. Boussaada, M. Ben Massoued, M. Mahjoub, M. Hassine, H. Gamra
{"title":"风湿性二尖瓣狭窄合并肺动脉高压患者左心房储备功能的评估","authors":"M.Y. Kallala, N. Bouchehda, S. Lamine, S. Kraeim, M. Boussaada, M. Ben Massoued, M. Mahjoub, M. Hassine, H. Gamra","doi":"10.1016/j.acvdsp.2023.04.056","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction</h3><p><span>The pathophysiology triggering dyspnea in rheumatic MS patients remains not fully understood. Recently introduced echocardiographic techniques allowed the study of left atrial reservoir function (LASr) notably </span>in patients with PH. The objective of this study was to assess the correlation between LASr determined by 2D STE derived from global LA strain and PH.</p></div><div><h3>Method</h3><p><span>We performed prospective 2D TTE in patients with rheumatic MS. 2D and doppler TTE parameters, including indexed LA volume, maximal trans tricuspid velocity (TRVmax), mean trans-mitral gradient (MTMG), valve area (MVA) using pressure half time (PHT), 2D and 3D planimetry and left ventricular index stroke volume, were recorded. Doppler parameters are determined as the mean of three measurements. Maximal TRVmax was used as an indicator of the degree of PH to ignore assumptions on the right atrial pressure. A TRVmax cut-off value</span> <!-->≥<!--> <!-->2.9<!--> <span>m/s was retained to determine an intermediate to high probability of PH. NYHA functional status was determined moments before performing the scan.</span></p></div><div><h3>Results</h3><p>We enrolled 195 patients with rheumatic MS, with a mean age of 50.55<!--> <!-->±<!--> <!-->12.07<!--> <!-->years (between February 2018 and October 2021). Patients were divided into two groups: group 1 had TRVmax<!--> <!-->≥<!--> <!-->2.9<!--> <!-->m/s and group 2 had TRVmax<!--> <!--><<!--> <!-->2.9<!--> <!-->m/s. There was no difference in age (52<!--> <!-->±<!--> <!-->12 vs. 49<!--> <!-->±<!--> <!-->11, <em>P</em> <!-->=<!--> <!-->0.16) and in sex (respectively 69.8% and 76.1% were female, <em>P</em> <!-->=<!--> <!-->0.3). AF was comparable between the two groups (69.8 vs. 65.7%, <em>P</em> <!-->=<!--> <!-->0.5). There was no difference in the incidence of severe dyspnea (48.8% vs. 43.1%, <em>P</em> <!-->=<!--> <!-->0.5 had NYHA class III or I symptoms). Incidence of diabetes mellitus was significantly higher among patients with PH (24.4 vs. 10.6%, <em>P</em> <!-->=<!--> <!-->0.02). Patients in the PH group had significantly higher MTMG (13<!--> <!-->±<!--> <!-->6 vs. 8<!--> <!-->±<!--> <!-->3<!--> <!-->mmHg, <em>P</em> <!--><<!--> <!-->0.001) and significantly lower MVA (1.1<!--> <!-->±<!--> <!-->0.5 vs. 1.5<!--> <!-->±<!--> <!-->0.5<!--> <!-->cm<sup>2</sup>, <em>P</em> <!--><<!--> <!-->0.001). LASr was significantly higher in patients without PH (11.1<!--> <!-->±<!--> <!-->7 vs. 8.9<!--> <!-->±<!--> <!-->5%, <em>P</em> <!-->=<!--> <!-->0.05).</p></div><div><h3>Conclusion</h3><p>LASr was associated with a lower incidence of pulmonary hypertension in patients with MS.</p></div>","PeriodicalId":8140,"journal":{"name":"Archives of Cardiovascular Diseases Supplements","volume":null,"pages":null},"PeriodicalIF":18.0000,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Assessment of left atrial reservoir function in rheumatic mitral stenosis with pulmonary hypertension\",\"authors\":\"M.Y. Kallala, N. Bouchehda, S. Lamine, S. Kraeim, M. Boussaada, M. Ben Massoued, M. Mahjoub, M. Hassine, H. Gamra\",\"doi\":\"10.1016/j.acvdsp.2023.04.056\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Introduction</h3><p><span>The pathophysiology triggering dyspnea in rheumatic MS patients remains not fully understood. Recently introduced echocardiographic techniques allowed the study of left atrial reservoir function (LASr) notably </span>in patients with PH. The objective of this study was to assess the correlation between LASr determined by 2D STE derived from global LA strain and PH.</p></div><div><h3>Method</h3><p><span>We performed prospective 2D TTE in patients with rheumatic MS. 2D and doppler TTE parameters, including indexed LA volume, maximal trans tricuspid velocity (TRVmax), mean trans-mitral gradient (MTMG), valve area (MVA) using pressure half time (PHT), 2D and 3D planimetry and left ventricular index stroke volume, were recorded. Doppler parameters are determined as the mean of three measurements. Maximal TRVmax was used as an indicator of the degree of PH to ignore assumptions on the right atrial pressure. A TRVmax cut-off value</span> <!-->≥<!--> <!-->2.9<!--> <span>m/s was retained to determine an intermediate to high probability of PH. NYHA functional status was determined moments before performing the scan.</span></p></div><div><h3>Results</h3><p>We enrolled 195 patients with rheumatic MS, with a mean age of 50.55<!--> <!-->±<!--> <!-->12.07<!--> <!-->years (between February 2018 and October 2021). Patients were divided into two groups: group 1 had TRVmax<!--> <!-->≥<!--> <!-->2.9<!--> <!-->m/s and group 2 had TRVmax<!--> <!--><<!--> <!-->2.9<!--> <!-->m/s. There was no difference in age (52<!--> <!-->±<!--> <!-->12 vs. 49<!--> <!-->±<!--> <!-->11, <em>P</em> <!-->=<!--> <!-->0.16) and in sex (respectively 69.8% and 76.1% were female, <em>P</em> <!-->=<!--> <!-->0.3). AF was comparable between the two groups (69.8 vs. 65.7%, <em>P</em> <!-->=<!--> <!-->0.5). There was no difference in the incidence of severe dyspnea (48.8% vs. 43.1%, <em>P</em> <!-->=<!--> <!-->0.5 had NYHA class III or I symptoms). Incidence of diabetes mellitus was significantly higher among patients with PH (24.4 vs. 10.6%, <em>P</em> <!-->=<!--> <!-->0.02). Patients in the PH group had significantly higher MTMG (13<!--> <!-->±<!--> <!-->6 vs. 8<!--> <!-->±<!--> <!-->3<!--> <!-->mmHg, <em>P</em> <!--><<!--> <!-->0.001) and significantly lower MVA (1.1<!--> <!-->±<!--> <!-->0.5 vs. 1.5<!--> <!-->±<!--> <!-->0.5<!--> <!-->cm<sup>2</sup>, <em>P</em> <!--><<!--> <!-->0.001). 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引用次数: 0
摘要
引发风湿性MS患者呼吸困难的病理生理机制尚不完全清楚。最近引入的超声心动图技术允许研究左心房储层功能(LASr)，特别是在ph患者中。本研究的目的是评估由全局LA strain获得的2D STE测定的LASr与ph之间的相关性。方法我们对风湿性ms患者进行前瞻性2D TTE, 2D和多普勒TTE参数包括LA容积指数，最大跨三尖瓣速度(TRVmax)，平均跨二尖瓣梯度(MTMG)，采用压力半时间法(PHT)、二维、三维平面测量法记录瓣膜面积(MVA)、左室指数、脑卒中容积。多普勒参数确定为三次测量的平均值。使用最大TRVmax作为PH程度的指标，忽略对右心房压的假设。保留TRVmax临界值≥2.9 m/s，以确定ph的中高概率。在进行扫描之前确定NYHA功能状态。结果纳入195例风湿性MS患者，平均年龄为50.55±12.07岁(2018年2月至2021年10月)。患者分为两组:组1 TRVmax≥2.9 m/s，组2 TRVmax <2.9米/秒。年龄(52±12比49±11,P = 0.16)、性别(女性分别为69.8%和76.1%，P = 0.3)差异无统计学意义。两组间房颤具有可比性(69.8比65.7%，P = 0.5)。严重呼吸困难的发生率无差异(48.8% vs 43.1%， P = 0.5)。PH组糖尿病发生率明显高于PH组(24.4% vs. 10.6%， P = 0.02)。PH组患者MTMG显著升高(13±6比8±3 mmHg, P <0.001)， MVA显著降低(1.1±0.5 vs. 1.5±0.5 cm2, P <0.001)。无PH患者LASr显著高于无PH患者(11.1±7% vs 8.9±5%，P = 0.05)。结论lasr可降低MS患者肺动脉高压的发生率。
Assessment of left atrial reservoir function in rheumatic mitral stenosis with pulmonary hypertension
Introduction
The pathophysiology triggering dyspnea in rheumatic MS patients remains not fully understood. Recently introduced echocardiographic techniques allowed the study of left atrial reservoir function (LASr) notably in patients with PH. The objective of this study was to assess the correlation between LASr determined by 2D STE derived from global LA strain and PH.
Method
We performed prospective 2D TTE in patients with rheumatic MS. 2D and doppler TTE parameters, including indexed LA volume, maximal trans tricuspid velocity (TRVmax), mean trans-mitral gradient (MTMG), valve area (MVA) using pressure half time (PHT), 2D and 3D planimetry and left ventricular index stroke volume, were recorded. Doppler parameters are determined as the mean of three measurements. Maximal TRVmax was used as an indicator of the degree of PH to ignore assumptions on the right atrial pressure. A TRVmax cut-off value ≥ 2.9 m/s was retained to determine an intermediate to high probability of PH. NYHA functional status was determined moments before performing the scan.
Results
We enrolled 195 patients with rheumatic MS, with a mean age of 50.55 ± 12.07 years (between February 2018 and October 2021). Patients were divided into two groups: group 1 had TRVmax ≥ 2.9 m/s and group 2 had TRVmax < 2.9 m/s. There was no difference in age (52 ± 12 vs. 49 ± 11, P = 0.16) and in sex (respectively 69.8% and 76.1% were female, P = 0.3). AF was comparable between the two groups (69.8 vs. 65.7%, P = 0.5). There was no difference in the incidence of severe dyspnea (48.8% vs. 43.1%, P = 0.5 had NYHA class III or I symptoms). Incidence of diabetes mellitus was significantly higher among patients with PH (24.4 vs. 10.6%, P = 0.02). Patients in the PH group had significantly higher MTMG (13 ± 6 vs. 8 ± 3 mmHg, P < 0.001) and significantly lower MVA (1.1 ± 0.5 vs. 1.5 ± 0.5 cm2, P < 0.001). LASr was significantly higher in patients without PH (11.1 ± 7 vs. 8.9 ± 5%, P = 0.05).
Conclusion
LASr was associated with a lower incidence of pulmonary hypertension in patients with MS.
期刊介绍：
Archives of Cardiovascular Diseases Supplements is the official journal of the French Society of Cardiology. The journal publishes original peer-reviewed clinical and research articles, epidemiological studies, new methodological clinical approaches, review articles, editorials, and Images in cardiovascular medicine. The topics covered include coronary artery and valve diseases, interventional and pediatric cardiology, cardiovascular surgery, cardiomyopathy and heart failure, arrhythmias and stimulation, cardiovascular imaging, vascular medicine and hypertension, epidemiology and risk factors, and large multicenter studies. Additionally, Archives of Cardiovascular Diseases also publishes abstracts of papers presented at the annual sessions of the Journées Européennes de la Société Française de Cardiologie and the guidelines edited by the French Society of Cardiology.
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