严重器质性二尖瓣反流患者肺动脉压的预测因素

摘要

目的 探讨严重器质性二尖瓣反流患者肺动脉收缩压(PASA)升高的预测因素及与左右心室收缩、舒张功能的关系.方法 二尖瓣脱垂或连枷样引起的中-重度二尖瓣反流患者694例,男361例,女333例,年龄17～57岁,均行常规超声心动图检查并行组织多普勒(TDI)分析,根据三尖瓣反流速度测算PASP;合并EF%<55%及原发性肺动脉高压患者予以排除.根据PASA数值由低至高分成四组,作相关因素分析比较.结果 PASP平均为(40±15)mmHg,与年龄(r=0.36,P<0.01)、MR(r=0.30,P<0.01)、二尖瓣瓣环E/E(侧壁,r=0.40,P<0.01;室间隔,r=0.41,P<0.01)、左心房内径指数(r=0.50,P<0.01)、右心室内经指数(r=0.30,P<0.01)、左心室及右心室舒张功能参数均有很好的相关性,这些变量随PASP的增加而增加;PASP与二尖瓣瓣环TDI收缩期速度、左心室射血分数、左心室短轴缩短率的相关性则较差.多变量分析结果提示,年龄、MR、左心房大小,以及左心室充盈压指标E/E(侧壁、室间隔)是PASP升高的独立性预测因子.结论 二尖瓣脱垂或连枷样二尖瓣引起中-重度器质性二尖瓣反流且左心室收缩功能尚正常的患者,年龄、MR、左心房内径、左心室充盈压及左、右心室舒张功能指标对PASP有预测作用.%Objective Presence of pulmonary hypertension is an important consideration for mitral valve ( MV) surgery in pts with significant organic mitral regurgitation ( MR) . This study is to explore determinants of pulmonary artery systolic pressure (PASP) and its relations to left ventricular (LV) and right ventricular (RV) functions in this setting. Methods Consecutive patients ( n =694, 57 ± 17yrs, 52% male) with moderate to severe MR secondary to mitral valve prolapse (MVP) or flail mitral valve. Echocardiography was performed with tissue Doppler imaging (TDI). Patients with LV ejection faction < 55% and primary pulmonary hypertension were excluded. All Patients were categorized into quartiles (Q) according to PASP. Results Mean PASP was 40 ±15 mmHg; Significant increments in mean age, MR volume, mitral annular E/E'( lateral and septal) , left atrial (LA) dimensionindex, right ventricular (RV) dimensionindex, LV and RV diastolic indices across the Qs; PASP correlated well with these univariate predictors; though it correlated poorly with mitral annular TD systolic velocity, LV eject fraction and LV fractional shortening; Multivariate analysis showed age, LA size and LV filling parameters (E/E") to be independent predictors of PASP (all P <0. 001). Conclusion In patients with moderate to severe MR secondary to MVP or flail mitral valve and preserved LV systolic function, PASP is predicted by age, MR severity, LA size, LV filling pressure, LV and RV diastolic functions.