成比例与不成比例二尖瓣反流超声心动图评估与进展

Echocardiographic assessment of progression of proportional and disproportional mitral regurgitation

二尖瓣反流是常见的心脏瓣膜病,其中继发性二尖瓣反流占比较高,预后较差。以往在二尖瓣反流患者的临床管理决策中,未充分考虑左室重构程度与心功能改变的影响,使合理的个体化治疗方案的制定缺乏充分依据。近年来,临床观察与研究表明,左室舒张末期容积和左室射血分数与有效反流口面积及反流容积呈内在相关,影响疾病和进展与预后。依据反流程度与左室重构程度的比例关系,继发性二尖瓣反流可分为“成比例”与“不成比例”两类亚型,此分类有助于临床管理决策。超声心动图是评价二尖瓣反流与左室重构程度的首选影像学方法,本文旨在介绍超声心动图在“成比例”与“不成比例”继发性二尖瓣反流中的应用与研究进展。

Mitral regurgitation is a common valvular heart disease,among which secondary mitral regurgitation has large proportion and poor prognosis.Previously,clinical management decisions for patients with mitral regurgitation did not fully consider the impact of left ventricular remodeling and cardiac function changes,resulting in a lack of sufficient evidence for the formulation of reasonable individualized treatment plans.Clinical observations and studies in recent years have revealed that the left ventricular end-diastolic volume and ejection fraction are intrinsically correlated with the effective regurgitational orifice area and regurgitational volume,which affect disease progression and prognosis.Secondary mitral regurgitation can be categorized into"proportional"and"disproportionate"subtypes based on the proportional connection between the degree of regurgitation and the degree of left ventricular remodeling,which can aid in clinical therapy decisions.Echocardiography is the preferred imaging method to evaluate the degree of mitral regurgitation and left ventricular remodeling.This paper reviews the clinical application and research progress of echocardiography in"proportional"and"disproportionate"secondary mitral regurgitation.