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首页> 美国卫生研究院文献>Cardiovascular Diseases >Slope of the Anterior Mitral Valve Leaflet: A New Measurement of Left Ventricular Unloading for Left Ventricular Assist Devices and Systolic Dysfunction
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Slope of the Anterior Mitral Valve Leaflet: A New Measurement of Left Ventricular Unloading for Left Ventricular Assist Devices and Systolic Dysfunction

机译：二尖瓣前瓣小叶的坡度：左心室辅助装置和收缩功能障碍的左心室卸载的新测量

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Left ventricular assist device (LVAD)-supported patients are evaluated routinely with use of transthoracic echocardiography. Values of left ventricular unloading in this unique patient population are needed to evaluate LVAD function and assist in patient follow-up.We introduce a new M-mode measurement, the slope of the anterior mitral valve leaflet (SLAM), and compare its efficacy with that of other standard echocardiographically evaluated values for left ventricular loading, including E/e′ and pulmonary artery systolic pressures. Average SLAM values were determined retrospectively for cohorts of random, non-LVAD patients with moderately to severely impaired left ventricular ejection fraction (LVEF) (<0.35, n=60). In addition, pre- and post-LVAD implantation echocardiographic images of 81 patients were reviewed.The average SLAM in patients with an LVEF <0.35 was 11.6 cm/s (95% confidence interval, 10.4–12.8); SLAM had a moderately strong correlation with E/e′ in these patients. Implantation of LVADs significantly increased the SLAM from 7.3 ± 2.44 to 14.7 ± 5.01 cm/s (n=42, P <0.0001). The LVAD-supported patients readmitted for exacerbation of congestive heart failure exhibited decreased SLAM from 12 ± 3.93 to 7.3 ± 3.5 cm/s (n=6, P=0.041). In addition, a cutpoint of 10 cm/s distinguished random patients with LVEF <0.35 from those in end-stage congestive heart failure (pre-LVAD) with an 88% sensitivity and a 55% specificity.Evaluating ventricular unloading in LVAD patients remains challenging. Our novel M-mode value correlates with echocardiographic values of left ventricular filling in patients with moderate-to-severe systolic function and dynamically improves with the ventricular unloading of an LVAD.
机译：常规使用经胸超声心动图评估左心辅助设备（LVAD）支持的患者。在此独特的患者人群中需要左心室卸载值来评估LVAD功能并协助患者随访。我们引入了一种新的M型测量方法，即二尖瓣前叶（SLAM）的斜率，并将其疗效与其他标准超声心动图评估的左心室负荷值，包括E / e'和肺动脉收缩压。回顾性分析随机，非LVAD患者中度至严重左心室射血分数（LVEF）（<0.35，n = 60）的队列研究的平均SLAM值。此外，还回顾了81例LVAD植入前后的超声心动图图像。LVEF<0.35的患者的平均SLAM为11.6 cm / s（95％置信区间为10.4-12.8）。在这些患者中，SLAM与E / e'具有中等程度的强相关性。 LVAD的植入将SLAM从7.3±2.44 cm / s显着增加到14.7±5.01 cm / s（n = 42，P <0.0001）。 LVAD支持的再充血性心力衰竭加重患者的SLAM从12±3.93降至7.3±3.5 cm / s（n = 6，P = 0.041）。此外，以10 cm / s的临界值将LVEF <0.35的随机患者与末期充血性心力衰竭（LVAD之前）的患者区别开来，其敏感性为88％，特异性为55％。评估LVAD患者的心室负荷仍然是一项挑战。我们新的M模式值与收缩功能中至重度患者的左心室充盈的超声心动图值相关，并且随着LVAD的心室卸载而动态改善。

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