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배경 및 목적:좌심실 용적 증가를 유발하는 만성승모판폐쇄부전(MR)과 대동맥판폐쇄부전(AR)환자의 수술 후 좌심실기능 예측은 아직 어려운 실정이다. 따라서 저자들은 상기 질환에서 수술 전 2-dimensional peak negative longitudinal strain(LS2D)이 수술 후 좌심실기능 예측에 유용한 것인지 알아보고자 하였다.방 법:26명의 MR 환자와 22명의 AR 환자에서 새로 개발된 speckle tracking image를 이용하여 수술 전 LS2D를 측정하였다. 수술 후 추적 관찰된 LV ejection fraction(EF)의 변화에 따라 favorable response(FR)는 다음과 같이 정의되었다: 1) 수술 전, 후 LVEF가 모두 55% 이상, 2) 수술 전 LVEF가 55% 미만, 45% 이상인 경우 수술 후 55% 이상, 3) 수술 전 LVEF가 45% 미만인 경우 수술 후 10% 이상 증가. 결 과: 수술 후 추적 심초음파는 평균 6.7±2.3개월에 시행되었고 36명이 FR(LVEF: 55.4±10.1에서 58.3±5.0, p=0.06) 나머지 12명이 unfavorable response(UFR, LVEF: 52.5±7.6에서 45.1±5.4%, p<0.01)을 보였다. 양 군간 연령, 성별, 기저 판막질환, 수술 전 좌심실 내경과 용적, 수술 방법, cardiopulmonary bypass time의 차이는 없었으며 수술 전 측정한 LS2D 만이 FR군에서 의미있게 컸다(-19.8±3.9% vs -16.2±2.9%, p<0.01). 또한, 수술 전 LS2D를 이용한 수술 후 UFR의 예측은 절단값 -18.3%에서 75%의 민감도와 특이도로 예측 가능한 것으로 나타났다. 결 론: MR과 AR 환자에서 수술 전 LS2D는 수술 후 좌심실 기능을 예측하기 위한 유용한 지표이다.


Background and Objectives:Prediction of the postoperative left ventricular (LV) function in valvular heart disease that will cause LV volume overloading, such as chronic mitral regurgitation (MR) and aortic regurgitation (AR), remains elusive. We sought to test if 2-dimensional peak negative longitudinal strain (LS2D) was useful for prediction of the postoperative LV function in relation to this disease entity. Subjects and Methods:Newly developed speckle tracking imaging was performed preoperatively to measure the LS2D in 26 and 22 patients with MR and AR, respectively. A favorable response after the operation (FR) was defined according to the change in the LV ejection fraction (EF): 1) a LVEF ≥55% both pre- and post-operation, 2) a postoperative LVEF ≥55% with a pre-operative LVEF between <55 and ≥45%, or 3) an increase in the LVEF >10% with a pre-operative LVEF <45%. Results:Follow-up echocardiography was performed at an average of 6.7±2.3 months after the operation. FR was confirmed in 36 patients (LVEF from 55.4±10.1 to 58.3±5.0%, p=0.06), with the remaining 12 showing an unfavorable response (LVEF from 52.5±7.6 to 45.1±5.4%, p<0.01). There was no significant difference in the baseline characteristics, including underlying etiologies, operation techniques, and cardiopulmonary bypass time, and LV volumes and EF between the two groups. The only difference was the LS2D, which was significantly larger in the FR group (-19.8±3.9 versus -16.2±2.9%, p<0.01). An LS2D of -18.3% could predict an unfavorable response of the LVEF following an operation, with a sensitivity and specificity of 75 and 75%, respectively. Conclusion:The preoperative LS2D is a useful predictor of the postoperative left ventricular function in AR and MR. (Korean Circulation J 2006;36:272-278)


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Aortic valve insufficiency;Mitral valve insufficiency;Echocardiography, transthoracic.