M.Y. Kallala, N. Bouchehda, S. Lamine, S. Kraeim, M. Boussaada, M. Ben Massoued, M. Mahjoub, M. Hassine, H. Gamra
{"title":"Which factors are associated with low flow in rheumatic mitral stenosis patients?","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.2023.04.055","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction</h3><p>Stroke volume (SV) raised enthusiasm in the early investigations of rheumatic MS pathophysiology and was considered as a key component triggering dyspnea. Giving the discrepancies uncovered in later studies, its importance was later downgraded. The objective of this study was to assess correlations between LA reservoir function (LASr) and global left ventricular longitudinal strain (LVS) determined by 2D STE and stroke volume index (SVI).</p></div><div><h3>Method</h3><p><span>We performed TTE in a cohort of patients with rheumatic MS. Basic 2D and doppler parameters were recorded such as mean trans-mitral gradient (MTMG), mitral valve area (MVA) with 2D planimetry and PHT. Studied parameters represent mean of three consecutive cardiac cycles. LASr data was obtained on a dedicated 4C view with STE technique. LVS was generated based on the 3 basic apical views. Low-flow state was defined as a SVI</span> <!-->≤<!--> <!-->35<!--> <!-->mL/m<sup>2</sup>.</p></div><div><h3>Results</h3><p>One hundred and ninety-five patients were included between February 2018 and October 2021. We divided our cohort into two groups: group I with SVI<!--> <!-->≤<!--> <!-->35<!--> <!-->mL/m<sup>2</sup> and group II with SVI<!--> <!-->><!--> <!-->35<!--> <!-->mL/m<sup>2</sup>. There was not a significant difference in terms of age (49.8<!--> <!-->±<!--> <!-->12 vs. 51.6<!--> <!-->±<!--> <!-->10<!--> <!-->yrs, <em>P</em> <!-->=<!--> <!-->0.3), sex (70.7 vs. 72.2% were female, <em>P</em> <!-->=<!--> <!-->0.8) and history of atrial fibrillation (67.4 vs. 55.7%, <em>P</em> <!-->=<!--> <!-->0.09). 2D MVA was significantly lower in group I (1.22<!--> <!-->±<!--> <!-->0.4 vs. 1.43<!--> <!-->±<!--> <!-->0.5<!--> <!-->cm<sup>2</sup>, <em>P</em> <!-->=<!--> <!-->0.003). Surprisingly, MVA determined with PHT did not significantly differ (1.43<!--> <!-->±<!--> <!-->0.6 vs. 1.39<!--> <!-->±<!--> <!-->0.4<!--> <!-->cm<sup>2</sup>, <em>P</em> <!-->=<!--> <!-->0.5). The incidence of severe dyspnea was (44.3 vs. 44.4%, <em>P</em> <!-->=<!--> <!-->0.9). TRVmax levels (3.23<!--> <!-->±<!--> <!-->0.6 vs. 3.07<!--> <!-->±<!--> <!-->0.6<!--> <!-->m/s, <em>P</em> <!-->=<!--> <!-->0.14) were comparable. Group I had significantly higher MTMG (12.1<!--> <!-->±<!--> <!-->7 vs. 9.8<!--> <!-->±<!--> <!-->4<!--> <!-->mmHg, <em>P</em> <!-->=<!--> <!-->0.01). LVS and LVEF were significantly lower in low-flow patients: (−15<!--> <!-->±<!--> <!-->4 vs. −18<!--> <!-->±<!--> <!-->2%, <em>P</em> <!--><<!--> <!-->0.001) and (61.1<!--> <!-->±<!--> <!-->8% vs. 64.2<!--> <!-->±<!--> <!-->5%, <em>P</em> <!-->=<!--> <!-->0.04) respectively. LASr was higher in normal flow patients but did not reach the statistical significance. (9.5<!--> <!-->±<!--> <!-->7 vs. 11.5<!--> <!-->±<!--> <!-->6%, <em>P</em> <!-->=<!--> <!-->0.062).</p></div><div><h3>Conclusion</h3><p>MVA, LVS and LVEF were significant associates of low-flow state in MS patients. LA reservoir function was not significantly correlated to SVI.</p></div>","PeriodicalId":8140,"journal":{"name":"Archives of Cardiovascular Diseases Supplements","volume":"15 3","pages":"Page 269"},"PeriodicalIF":18.0000,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Archives of Cardiovascular Diseases Supplements","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1878648023001945","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"Medicine","Score":null,"Total":0}
引用次数: 0
Abstract
Introduction
Stroke volume (SV) raised enthusiasm in the early investigations of rheumatic MS pathophysiology and was considered as a key component triggering dyspnea. Giving the discrepancies uncovered in later studies, its importance was later downgraded. The objective of this study was to assess correlations between LA reservoir function (LASr) and global left ventricular longitudinal strain (LVS) determined by 2D STE and stroke volume index (SVI).
Method
We performed TTE in a cohort of patients with rheumatic MS. Basic 2D and doppler parameters were recorded such as mean trans-mitral gradient (MTMG), mitral valve area (MVA) with 2D planimetry and PHT. Studied parameters represent mean of three consecutive cardiac cycles. LASr data was obtained on a dedicated 4C view with STE technique. LVS was generated based on the 3 basic apical views. Low-flow state was defined as a SVI ≤ 35 mL/m2.
Results
One hundred and ninety-five patients were included between February 2018 and October 2021. We divided our cohort into two groups: group I with SVI ≤ 35 mL/m2 and group II with SVI > 35 mL/m2. There was not a significant difference in terms of age (49.8 ± 12 vs. 51.6 ± 10 yrs, P = 0.3), sex (70.7 vs. 72.2% were female, P = 0.8) and history of atrial fibrillation (67.4 vs. 55.7%, P = 0.09). 2D MVA was significantly lower in group I (1.22 ± 0.4 vs. 1.43 ± 0.5 cm2, P = 0.003). Surprisingly, MVA determined with PHT did not significantly differ (1.43 ± 0.6 vs. 1.39 ± 0.4 cm2, P = 0.5). The incidence of severe dyspnea was (44.3 vs. 44.4%, P = 0.9). TRVmax levels (3.23 ± 0.6 vs. 3.07 ± 0.6 m/s, P = 0.14) were comparable. Group I had significantly higher MTMG (12.1 ± 7 vs. 9.8 ± 4 mmHg, P = 0.01). LVS and LVEF were significantly lower in low-flow patients: (−15 ± 4 vs. −18 ± 2%, P < 0.001) and (61.1 ± 8% vs. 64.2 ± 5%, P = 0.04) respectively. LASr was higher in normal flow patients but did not reach the statistical significance. (9.5 ± 7 vs. 11.5 ± 6%, P = 0.062).
Conclusion
MVA, LVS and LVEF were significant associates of low-flow state in MS patients. LA reservoir function was not significantly correlated to SVI.
卒中量(SV)在风湿病MS病理生理学的早期研究中提高了人们的热情，被认为是引发呼吸困难的关键因素。考虑到后来的研究发现的差异，它的重要性后来被降低了。本研究的目的是评估左室储层功能(LASr)与2D STE和脑卒中容积指数(SVI)测定的左室纵向应变(LVS)之间的相关性。方法对一组风湿性ms患者行TTE手术，记录二维平面测量和PHT下的平均二尖瓣斜度(MTMG)、二尖瓣面积(MVA)等基本二维和多普勒参数。研究参数为三个连续心动周期的平均值。LASr数据是用STE技术在专用的4C视图上获得的。LVS是基于3个基本顶点视图生成的。低流量状态定义为SVI≤35 mL/m2。结果2018年2月至2021年10月共纳入195例患者。我们将研究对象分为两组:SVI≤35 mL/m2的I组和SVI >的II组;35毫升/ m2。年龄(49.8±12岁比51.6±10岁，P = 0.3)、性别(70.7比72.2%为女性，P = 0.8)、房颤史(67.4比55.7%，P = 0.09)差异无统计学意义。I组2D MVA明显降低(1.22±0.4 vs 1.43±0.5 cm2, P = 0.003)。令人惊讶的是，PHT测定的MVA没有显著差异(1.43±0.6 vs 1.39±0.4 cm2, P = 0.5)。严重呼吸困难的发生率为(44.3% vs. 44.4%， P = 0.9)。TRVmax水平(3.23±0.6 vs 3.07±0.6 m/s, P = 0.14)具有可比性。组MTMG明显增高(12.1±7∶9.8±4 mmHg, P = 0.01)。低流量患者LVS和LVEF显著降低:(- 15±4% vs - 18±2%，P <0.001)和(61.1±8%和64.2±5%,P = 0.04)。血流正常患者LASr较高，但未达到统计学意义。(9.5±7%比11.5±6%，P = 0.062)。结论mva、LVS和LVEF与MS患者低血流状态有显著相关性。LA水库功能与SVI无显著相关。
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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