russjcardiolРоссийский кардиологический журналRussian Journal of Cardiology1560-40712618-7620«SILICEA-POLIGRAF» LLC10.15829/1560-4071-2013-1-37-42russjcardiol-342Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESФУНКЦИЯ ЛЕВОГО ЖЕЛУДОЧКА ПРИ ПРОЛАПСЕ МИТРАЛЬНОГО КЛАПАНА, ОСЛОЖНЕННОМ ТЯЖЕЛОЙ МИТРАЛЬНОЙ НЕДОСТАТОЧНОСТЬЮLeft ventricular function in mitral valve prolapse and severe mitral regurgitationМалевЭ. Г.MalevE. G.

к. м.н., докторант, ведущий научный сотрудник НИЛ соединительнотканных дисплазий

edwardmalev@hotmail.comКимГ. И.KimG. I.

клинический ординатор кафедры кардиохирургии и кардиологии

МитрофановаЛ. Б.MitrofanovaL. B.

д. м.н., заведующая НИЛ патоморфоло-гии

ОмельченкоМ. Ю.OmelchenkoM. Yu.

к. м.н., науч. сотрудник НИЛ профилактической кардиологии

ЗемцовскийЭ. В.ZemtsovskyE. V.

д. м.н., профессор, зав. НИЛ соединительнотканных дисплазий, зав. кафедрой пропедевтики внутренних болезней

ФГБУ Федеральный центр сердца, крови и эндокринологии им. В. А. Алмазова МЗ РФ, Санкт-Петербург, РоссияРоссияV. A. Almazov Federal Centre of Heart, Blood, and Endocrinology, St. Petersburg, RussiaRussian Federation201328022013013742Copyright © Малев Э.Г., Ким Г.И., Митрофанова Л.Б., Омельченко М.Ю., Земцовский Э.В., 20132013Малев Э.Г., Ким Г.И., Митрофанова Л.Б., Омельченко М.Ю., Земцовский Э.В.Malev E.G., Kim G.I., Mitrofanova L.B., Omelchenko M.Y., Zemtsovsky E.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://russjcardiol.elpub.ru/jour/article/view/342Цель

Цель. Оценка систолической функции ЛЖ у пациентов с ПМК в зависимости от выраженности морфологических изменений митрального клапана.

 

 

Материал и методы

Материал и методы. В исследование было включено 233 пациента (средний возраст – 53,8±12,9 лет), которым была выполнена пластика или протезирование МК по поводу тяжелой МР вследствие ПМК в Федеральном Центре сердца, крови и эндокринологии им. В. А. Алмазова в период с 2009 по 2011 годы. Оценивались данные морфологического исследования резецированных сегментов МК. Продольная деформация и СД определялись по двухмерным серошкальным изображениям (рабочая станция EchoPAC’08).

 

 

Результаты

Результаты. По данным морфологического исследования, у 60 пациентов (25,8%) был выявлен миксоматоз створок, у 173 пациентов (74,2%) – фибро-эластиновая недостаточность. При дооперационном эхокардиографическом исследовании достоверных различий между группами по объему предоперационной МР (70,5±9,6 мл против 71,6±8,5 мл, р=0,40), систолической (фракция выброса по Симпсону: 52,7±6,6% против 52,0±7,4%, p=0,53) и диастолической (E/e’: 12,2±3,9 против 12,8±4,2, p=0,35) функций ЛЖ не было. Несмотря на отсутствие разницы во фракции выброса, у пациентов с миксоматозом

створок было выявлено существенное снижение продольной систолической (-13,5±2,2% против –16,6±2,3%, p=0,008) деформации, диастолической (1,14±0,20 с-1 против 1,34±0,18 с-1, p=0,04) и систолической (-0,89±0,15 с-1 против –1,14±0,15 с-1, p=0,002) СД по сравнению с пациентами с ФЭН.

 

 

Заключение

Заключение. Пациенты с выраженным миксоматозом МК имеют худший предоперационный контрактильный резерв по сравнению с пациентами с ФЭН, что может сказаться на выживаемости в отдаленном послеоперационном периоде. Данное снижение может быть обусловлено нарушением строения не только эндокардиального, но и интрамиокардиального внеклеточного матрикса при выраженном миксоматозе створок МК.

Aim

Aim. To assess systolic left ventricular (LV) function in patients with mitral valve prolapse (MVP) and different morphological MV disorders.

 

 

Material and methods

Material and methods. The study included 233 patients (mean age 53,8±12,9 years), who underwent MV surgery due to MPV and severe mitral regurgitation (MR) at the V. A. Almazov Federal Centre of Heart, Blood, and Endocrinology in 2009-2011. The resected MV segments underwent a pathomorphological examination; preoperative strain and strain rate were assessed with the speckle tracking method (EchoPAC’08).

 

 

Results

Results. Based on the pathomorphological data, Barlow’s disease was registered in 60 patients (25,8%), and fibroelastic deficiency in 173 patients (74,2%). The preintervention echocardiography did not demonstrate any significant difference between the two groups in terms of preoperative MR volume (70,5±9,6 ml vs. 71,6±8,5 ml, p=0,40), systolic LV function (ejection fraction 52,7±6,6% vs. 52,0±7,4%; p=0,53) and diastolicLV function (E/e’ 12,2±3,9 vs. 12,8±4,2; p=0,35). Despite no difference in ejection fraction, the Barlow’s disease group demonstrated a significant reduction inLV longitudinal systolic (-13,5±2,2% vs. -16,6±2,3%; p=0,008) and diastolic strain (1,14±0,20 s-1 vs. 1,34±0,18 s-1; p=0,04), as well as in strain rate (-0.89±0,15 s-1 vs. -1,14±0,15 s-1; p=0,002), compared to the fibroelastic deficiency group.

 

 

Conclusion

Conclusion. Patients with Barlow’s disease, compared to patients with fibroelastic deficiency, have a lower preoperative LV systolic function, which might affect the postoperative long-term survival rates. The deteriorated LV function could be due to the damage of endocardial and intramyocardial extracellular matrix in Barlow’s disease.

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The authors declare that there are no conflicts of interest present.