风湿性心脏病二尖瓣狭窄患者左心房功能对继发性三尖瓣反流的影响

目的探讨风湿性心脏病二尖瓣狭窄患者左心房大小及功能对继发性三尖瓣反流的影响。 方法选取2015年2月至2017年2月来阜外医院就诊的中度或重度风湿性心脏病二尖瓣狭窄患者67例,所有患者均行二尖瓣人工瓣膜置换手术,并于术前行超声心动图检查,均明确存在继发性三尖瓣反流。选取2016年于阜外医院就诊的门诊患者20例作为正常对照组,且均于就诊时行超声心动图检查。对研究组与正常对照组各项超声参数及左心房功能进行比较,对研究组左心房功能与三尖瓣结构及功能的相关性及继发性三尖瓣反流的影响因素进行分析。 结果研究组患者的三尖瓣瓣环直径指数与左心房面积变化率、排空分数及左心房平均应变呈强相关性（r=-0.65、-0.58和-0.59,P均<0.01）。肺动脉收缩压与左心房面积变化率、排空分数及左心房平均应变呈较强的负相关性（r=-0.60、-0.58和-0.59,P均<0.01）。Logistic多因素回归分析显示,三尖瓣瓣环直径指数、瓣叶闭合高度和肺动脉收缩压是影响术前继发性三尖瓣反流的相关因素（OR=1.916、2.382、1.059,95%CI：1.18~3.109、1.312~4.323、1.009~1.111,P均<0.05）。Logistic回归分析发现肺动脉收缩压、左心房面积变化率和左心房平均应变是影响三尖瓣瓣环增大的危险因素（OR=1.044、0.875、0.809,95%CI：1.002~1.088、0.761~0.964、0.656~0.997,P均<0.05）。 结论左心房扩大、功能减低参与了继发性三尖瓣反流的发生,左心房面积变化率和房壁平均应变减低会引发三尖瓣瓣环增大,从而导致三尖瓣反流的发生及加重。二维斑点追踪技术分析左心房应变可以提供更早期的左心房功能信息。

Influence of left atrial function on secondary tricuspid valve regurgitation in patients with rheumatic mitral stenosis

ObjectiveTo explore whether left atrial (LA) size and function influence secondary tricuspid regurgitation in patients with rheumatic mitral stenosis. MethodsSixty-seven patients diagnosed with moderate or severe rheumatic mitral stenosis from February 2015 to February 2017 at Fuwai Hospital were enrolled in our study. All patients underwent mitral valvular replacement and preoperative echocardiography. Secondary tricuspid regurgitation occurred in all patients. Twenty outpatients were enrolled as normal controls in our study and they also underwent echocardiography. Various echocardiography parameters and LA function were compared between the patients and normal controls. The correlations among LA function, tricuspid valvular morphology and function, and the influencing factors of secondary tricuspid regurgitation were analyzed. ResultsLA fraction of area change, LA ejection fraction, and average LA strain were strongly negatively correlated with tricuspid annular diameter index (r=-0.65, -0.58, and -0.59, respectively; P<0.01) and pulmonary artery systolic pressure (r=-0.60, -0.58, and -0.59, respectively; P<0.01). Logistic regression analysis demonstrated that tricuspid annular diameter index, leaflet tethering distance, and pulmonary artery systolic pressure were influencing factors of secondary tricuspid regurgitation (OR=1.916, 2.382, and 1.059; 95%CI: 1.18-3.109, 1.312-4.323, and 1.009-1.111, respectively; P<0.05). Logistic regression also showed that pulmonary artery systolic pressure, LA fraction of area change, and average LA strain were risk factors for increased tricuspid annular diameter index (OR=1.044, 0.875,and 0.809; 95%CI: 1.002-1.088, 0.761-0.964, and 0.656-0.997, respectively; P<0.05). ConclusionSecondary tricuspid regurgitation is influenced by enlarged LA and decreased LA function. Decreased LA fraction of area change and average LA strain can lead to tricuspid annular diameter dilatation, and induce or worsen secondary tricuspid regurgitation. Two dimensional speckle tracking technique could provide early information of LA function.