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Associations of aortic and mitral regurgitation with body composition and myocardial energy expenditure in adults with hypertension: The Hypertension Genetic Epidemiology Network study

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AMERICAN HEART JOURNAL 2003年第6期145卷 1071-1077页

作者： Palmieri, V Bella, JN Arnett, DK Oberman, A Kitzman, DW Hopkins, PN Rao, DC Roman, MJ Devereux, RB Cornell Univ Weill Med Coll New York NY USA Univ Minnesota Minneapolis MN USA Univ Birmingham Birmingham AL USA Wake Forest Univ Bowman Gray Sch Med Winston Salem NC USA Univ Utah Sch Med Salt Lake City UT USA Washington Univ Sch Med St Louis MO USA

Background it has been reported that aortic regurgitation, mitral valve regurgitation, or both are associated with lower body mass index, an index of body adiposity. However, the relations of valvular regurgitation to body composition and myocardial bioenergetic expenditure have not been previously investigated in a population-based sample. Methods We selected 1496 patients with hypertension who did not have diabetes mellitus to participate in the Hypertension Genetic Epidemiology Network (HyperGEN) study. We excluded participants with severe aortic or mitral stenosis or with known coronary heart disease. Bioimpedance was used to assess body composition. Echocardiography was used to assess left ventricular (LV) structure and function and to calculate myocardial workload (expressed as energy expenditure) from end-systolic stress, ejection time, and stroke volume. The study sample was divided into groups without mitral or aortic regurgitation (control subjects, n = 1175), with mild valvular regurgitation (1 +, n = 246), and with at least moderate (greater than or equal to2+) mitral or aortic regurgitation (n = 75). Results The mean patient age was higher with more severe valvular insufficiency. Sex distribution and blood pressure were similar among the 3 groups. Body mass index and fat mass were significantly lower with more severe valvular regurgitation, whereas fat-free mass was only slightly lower in the group with greater than or equal to2+ regurgitation compared with control subjects. Skinfold thicknesses (brachial and subscapular) were lower with more severe valvular regurgitation, whereas self-reported physical activity per week was similar among the 3 groups. LV mass and circumferential end-systolic stress were higher with more severe valvular regurgitation. Noninvasively estimated myocardial energy expenditure was slightly higher in participants with 1 + valvular regurgitation and-was significantly higher with greater than or equal to2+ regurgitation. Ejectio

关键词：脂肪组织/病理学主动脉瓣关闭不全/代谢主动脉瓣关闭不全/病理生理学身体成分病例对照研究超声心动描记术能量代谢心室/超声检查高血压/遗传学高血压/代谢高血压/病理生理学二尖瓣闭锁不全/代谢二尖瓣闭锁不全/病理生理学心肌/代谢皮肤壁厚度心室功能左老年人女(雌)性人类男(雄)性中年人

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Characteristic cardiovascular manifestation in homozygous and heterozygous familial hypercholesterolemia

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AMERICAN HEART JOURNAL 1999年第3期137卷 410-418页

作者： Kawaguchi, A Miyatake, K Yutani, C Beppu, S Tsushima, M Yamamura, T Yamamoto, A Natl Cardiovasc Ctr Res Inst Dept Etiol & Pathophysiol Suita Osaka 565 Japan Natl Cardiovasc Ctr Res Inst & Hosp Dept Etiol & Pathophysiol Suita Osaka 565 Japan

Background The aortic valve dysfunction of patients with homozygous familial hypercholesterolemia (FH) suggests that hypercholesterolemia affects not only coronary arteries but also the aortic valve. We studied the aortic root of patients with homozygous FH and those of patients with heterozygous FH to characterize the premature atherosclerotic lesions by using histopathologic specimens, Methods and Results The aortic roots of 10 patients with homozygous FH, age 9 to 58 years, were studied by cardiac catheterization with several angiographies. The aortic roofs of 39 patients with heterozygous FH under age 60 years were also examined For aortic and mitral valvular functions by color Doppler echocardiography, and 30 normocholesterolemic patients with coronary artery disease were examined as control subjects. In addition, in 22 patients with FH and 20 control subjects, the internal diameter of the aortic annulus and the aortic ridge in cardiac cycles were measured. Of the 10 homozygotes with FH, 8 patients had aortic regurgitation demonstrated by aortography;3 ct them showed significant transvalvular pressure gradients. Stenotic changes of coronary ostia were observed in 8 of the 10 homozygotes with moderate coronary atherosclerosis. Of the 39 heterozygotes with FH, 10 patients had aortic regurgitation shown by Doppler echocardiography, as did only 1 of the 30 control subjects (P < .05). The average diameter and distensibility of the ascending aorta were significantly reduced in the heterozygotes compared with the control subjects, The surgically resected cusp specimens of aortic valves obtained from 1 homozygous and 1 heterozygous patient showed significant thickening of the cusp with foam cell infiltration. Conclusions :Premature atherosclerosis in FH had a characteristic distribution, affecting the aortic root dominantly. The involvement of the aortic valve indicating "hypercholesterolemic valvulopathy" was a peculiar feature of FH, especially ifs homozygous form, b

关键词：主动脉/病理学主动脉/病理生理学主动脉疾病/病因学主动脉疾病/放射摄影术主动脉疾病/超声检查主动脉瓣/病理学主动脉瓣/病理生理学主动脉瓣关闭不全/病因学主动脉瓣关闭不全/病理生理学主动脉瓣关闭不全/放射摄影术主动脉瓣狭窄/病因学主动脉造影术动脉硬化/病因学动脉硬化/放射摄影术动脉硬化/超声检查血压/生理学冠状血管造影术冠心病/超声检查超声心动描记术多普勒彩色泡沫细胞/病理学心脏导管插入术心脏瓣膜疾病/病因学心脏瓣膜疾病/病理生理学杂合子纯合子高胆固醇血症Ⅱ型/遗传学高胆固醇血症Ⅱ型/放射摄影术高胆固醇血症Ⅱ型/超声检查二尖瓣闭锁不全/病因学二尖瓣闭锁不全/病理生理学青少年成年人儿童女(雌)性人类男(雄)性中年人

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Relation of exercise capacity to left ventricular systolic function and diastolic filling in idiopathic or ischemic dilated cardiomyopathy

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AMERICAN JOURNAL OF CARDIOLOGY 1999年第5期83卷 728-734页

作者： Lapu-Bula, R Robert, A De Kock, M D'Hondt, AM Detry, JM Melin, JA Vanoverschelde, JL Univ Louvain Sch Med Div Cardiol Brussels Belgium Univ Louvain Sch Med Div Biostat Brussels Belgium

Although exercise intolerance is a cardinal symptom of patients with dilated cardiomyopathy (DC) and heart failure, the factors that limit exercise capacity in these patients remain a matter of debate. To assess the contribution of left ventricular (LV) diastolic filling to the variable exercise capacity of patients with DC, we studied 47 patients (60 +/- 12 years) with DC in stable mild-to-moderate heart failure with a mean LV ejection fraction of 28%. Exercise capacity was measured as total body peak oxygen consumption ((V)over dot O-2) during symptom-limited bicycle (10 W/min) and treadmill (modified Bruce protocol) exercise. LV systolic function and diastolic filling were assessed at rest before each exercise by M-mode, Doppler echocardiography, and radionuclide ventriculography. As expected, treadmill exercise always yielded higher peak (V)over dot O-2 than bicycle exercise (21 +/- 6 vs 18 +/- 5 ml/kg/min, range 12 to 35 and 7 to 30 ml/kg/min, respectively, p <0.001). Both of these (V)over dot O-2 measurements were highly reproducible (R = 0.98). With univariate analysis, close correlations were found between peak (V)over dot O-2 (with either exercise modalities) and Doppler indexes of LV diastolic filling, as well as with the radionuclide LV ejection fraction. Stepwise multiple regression analysis identified 3 nonexercise variables as independent correlates of peak (V)over dot O-2, Of which the most powerful was the E/A ratio (multiple r(2) = 0.38, p <0.0001), followed by peak A velocity (r(2) = 0.54, p <0.0001) and mitral regurgitation grade (r2 = 0.58, p = 0.024). In conclusion, our data indicate that in patients with DC, peak (V)over dot O-2 is better correlated to diastolic filling rather than systolic LV function. (C)1999 by Excerpta Medica, Inc.

关键词：方差分析血流速度/生理学心排血量/生理学心排血量低/病理生理学心肌病扩张型/病理生理学昼夜节律置信区间心舒期超声心动描记术超声心动描记术多普勒运动试验运动耐量用力/生理学门控血池显像二尖瓣闭锁不全/病理生理学心肌缺血/病理生理学回归分析休息/生理学每搏输出量/生理学心缩期心室功能左/生理学成年人老年人人类男(雄)性中年人

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Use of transesophageal echocardiography for postoperative evaluation of right ventricular function

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ANNALS OF THORACIC SURGERY 1999年第1期67卷 146-152页

作者： Ochiai, Y Morita, S Tanoue, Y Kawachi, Y Tominaga, R Yasui, H Kyushu Univ Fac Med Dept Cardiovasc Surg Higashi Ku Fukuoka 8128582 Japan

Background. No method has been available to assess the right ventricular (RV) pressure-volume relation in the operating room or intensive care unit. Left ventricular cross-sectional area measured by echocardiography using the technology of automated border detection has been used to construct left ventricular pressure-area (P-A) loops. In the human right ventricle, however, this approach has not been validated. Methods. We recorded RV P-A loops in 14 patients in the intensive care unit using transesophageal echocardiography. Multiple RV P-A loops were obtained by reducing preload with intravenous nitroglycerin, thereby elucidating the end-systolic P-A relation. Results. With an incremental dose of dobutamine, the slope of the RV end-systolic P-A relation increased (from 4.56 +/- 2.42 to 7.34 +/- 3.62 mm Hg/cm(2), p < 0.01), with no change in the x-axis intercept, which implied increased contractility. Furthermore, in the operating room we validated the use of RV cross-sectional area as a surrogate for RV volume by demonstrating the close correlation between the stroke area (maximal RV area minus minimal RV area) and stroke volume (r = 0.962;p < 0.0001). Conclusions. Tranesophageal echocardiography with automated border detection is a promising tool for elucidating RV function through the analysis of RV P-A loops.

关键词：超声心动描记术经食管心电描记术房间隔缺损/病理生理学房间隔缺损/外科学房间隔缺损/超声检查二尖瓣闭锁不全/病理生理学二尖瓣闭锁不全/外科学二尖瓣闭锁不全/超声检查手术后期间每搏输出量心室功能右心室压成年人老年人女(雌)性人类男(雄)性中年人

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Mitral regurgitation after atrioventricular node catheter ablation for atrial fibrillation and heart failure: Acute hemodynamic features

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AMERICAN HEART JOURNAL 1999年第6期138卷 1166-1175页

作者： Twidale, N Manda, V Holliday, R Boler, S Sparks, L Crain, J Carrier, S Bass Baptist Hosp Enid OK USA Medtron Inc Minneapolis MN USA

Background Radiofrequency catheter ablation of the atrioventricular node and pacemaker insertion have been associated with occasional development of mitral regurgitation (MR). Ventricular pacing might result in MR if (1) left ventricular (LV) compliance is decreased and/or (2) mitral valve leaflet apposition is disturbed. We studied acute hemodynamic changes resulting from initiation of ventricular pacing in patients undergoing ablation. Methods and Results Thirteen patients (10 men and 3 women) with a mean age of 73.4 +/- 8.6 years, with chronic atrial fibrillation and congestive heart failure, had permanent ventricular pacemaker insertion with lead placement at the right ventricular (RV) apex. The following hemodynamic recordings were obtained before ablation (during atrial fibrillation) and then immediately after ablation (during RV pacing): heart rate, mean arterial pressure, LV end-diastolic pressure (LVEDP), mean pulmonary capillary wedge pressure, V-wave amplitude, and cardiac index. Presence of MR was assessed by V-wave amplitude and the results of LV angiography. In patients who had MR, recordings were also obtained during temporary ventricular pacing from the RV outflow tract (RVOT). As a group there were no significant changes in any hemodynamic measurement. Before ablation, mild MR by LV angiogram was present in 5 patients, but none had large V-wave amplitude. After ablation, mild MR was present by LV angiogram in 6 patients, and in 3 of these patients large V-wave amplitude developed (mean amplitude 42.7 +/- 2.2 mm Hg;assigned to group 1). This was associated with a rise in LVEDP in 1 patient (consistent with reduced IV compliance), but LVEDP was unchanged in the other 2 patients (suggesting abnormal mitral valve leaflet apposition). All patients in group 1 exhibited a fall in V-wave amplitude when the pacing site was moved to the RVOT. Conclusions Both reduced LV compliance and disturbed mitral valve leaflet apposition contribute to MR after ablation.

关键词：心房颤动/病理生理学心房颤动/外科学房室结慢性病随访研究二尖瓣闭锁不全/病因学二尖瓣闭锁不全/病理生理学预后心室功能右老年人老年人 80以上女(雌)性人类男(雄)性中年人

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Rapidly adapting receptors in a rabbit model of mitral regurgitation

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JOURNAL OF PHYSIOLOGY-LONDON 1999年第3期521卷 739-748页

作者： Gunawardena, S Bravo, E Kappagoda, CT Univ Calif Davis Div Cardiovasc Med Davis CA 95616 USA

1. Unlike in normal rabbits, pulmonary rapidly adapting receptors (RARs) in rabbits with chronic mitral regurgitation (MR) do not respond to small changes in extravascular fluid (EVF) volume in major airways. The present study examined the effect of shrinking the EVF volume in rabbits with chronic MR by infusing hypertonic albumin, to see whether this response of RARs is restored. The effect of raising the left atrial pressure (LAP) acutely above 25 mmHg (to cause pulmonary oedema) on RARs was also investigated. 2. Mean RAR activities in rabbits with MR (n = 6) at initial control, LAP +5 mmHg, LAP +10 mmHg and final control periods were 20.9 +/- 9.5, 18.8 +/- 11.3, 27.0 +/- 11.2 and 17.2 +/- 9.8 action potentials min(-1), respectively (P > 0.05, ANOVA). After infusion of 35% bovine serum albumin I.V. these values were 9.4 +/- 3.2, 30.6 +/- 14.6, 48.9 +/- 10.1 and 18.4 +/- 7.3 action potentials min(-1), respectively (P < 0.01, ANOVA). In rabbits with chronic MR (n = 7) raising the LAP above 25 mmHg stimulated RARs. 3. EVF content of the airways and lungs was measured in rabbits with MR and in control rabbits, at baseline and after elevation of the LAP by 10 or 25 mmHg for 20 min. In control rabbits the EVF contents in the lower trachea, carina and bronchi at baseline and at LAP +10 mmHg were 52.1 +/- 1.2 and 57.8 +/- 1.7%, respectively (P < 0.05, Student's t test). In rabbits with MR these values were 58.3 +/- 1.5 and 56.9 +/- 1.9%, respectively. When the LAP was elevated by 25 mmHg the EVF content increased to 62.4 +/- 1.1% (P < 0.05, t test compared with baseline and LAP + 10 mmHg). 4. We concluded that in rabbits with chronic MR, RARs are unable to respond to acute, small elevations of LAP because there is no concomitant increase in EVF content in the vicinity of these receptors. Furthermore, these receptors can be activated in these animals by elevating the LAP above 25 mmHg or can be made sensitive to acute small elevations of LAP by shrinking the chronically ex

关键词：动作电位/生理学适应生理学/生理学算法血压/生理学支气管/代谢超声心动描记术多普勒彩色电生理学血管外肺水/生理学心室/代谢高渗溶液肺/代谢肺/病理生理学机械感受器/生理学二尖瓣闭锁不全/病理生理学肺循环/生理学气管/代谢迷走神经/生理学动物兔

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Sudden death in mitral regurgitation due to flail leaflet

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JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 1999年第7期34卷 2078-2085页

作者： Grigioni, F Enriquez-Sarano, M Ling, LH Bailey, KR Seward, JB Tajik, AJ Frye, RL Mayo Clin & Mayo Fdn Div Cardiovasc Dis & Internal Med Rochester MN 55905 USA Mayo Clin & Mayo Fdn Biostat Sect Rochester MN 55905 USA

OBJECTIVES We sought to assess the incidence and determinants of sudden death (SUD) in mitral regurgitation due to flail leaflet (MR-FL). BACKGROUND Sudden death is a catastrophic complication of MR-FL. Its incidence and predictability are undefined. METHODS The occurrence of SUD was analyzed in 348 patients (age 67 +/- 12 years) with MR-FL diagnosed echocardiographically from 1980 through 1994. RESULTS During a mean follow-up of 48 +/- 41 months, 99 deaths occurred under medical treatment. Sudden death occurred in 25 patients, three of whom were resuscitated. The sudden death rates at five and 10 years were 8.6 +/- 2% and 18.8 +/- 4%, respectively, and the linearized rate was 1.8% per year. By multivariate analysis, the independent baseline predictors of SUD were New York Heart Association (NYHA) functional class (p = 0.006), ejection fraction (p = 0.0001) and atrial fibrillation (p = 0.059). The yearly linearized rate of sudden death was 1% in patients in functional class I, 3.1% in class II and 7.8% in classes III and IV. However, of 25 patients who had SUD, at baseline, 10 (40%) were in functional class I, 9 (36%) were in class II and only 6 (24%) in class III or IV. In five patients (20%), no evidence of risk factors developed until SUD. In patients with an ejection fraction greater than or equal to 60% and sinus rhythm, the Linearized rate of SUD was not different in functional classes I and II (0.8% per year). Surgical correction of MR (n = 186) was independently associated with a reduced incidence of SUD (adjusted hazard ratio [95% confidence interval] 0.29 [0.11 to 0.72], p = 0.007). CONCLUSIONS Sudden death is relatively common in patients with MR-FL who are conservatively managed. Patients with severe symptoms, atrial fibrillation and reduced systolic function are at higher risk, but notable rates of SUD have been observed without these risk factors. Correction of MR appears to be associated with a reduced incidence of SUD, warranting early consideration

关键词：猝死心脏/流行病学猝死心脏/病因学超声心动描记术多普勒发病率二尖瓣/畸形二尖瓣/诊断显像二尖瓣闭锁不全/并发症二尖瓣闭锁不全/死亡率二尖瓣闭锁不全/病理生理学预后回顾性研究每搏输出量老年人老年人 80以上女(雌)性人类男(雄)性中年人

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Relationship of ventricular longitudinal function to contractile reserve in patients with mitral regurgitation

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AMERICAN HEART JOURNAL 2003年第1期146卷 183-188页

作者： Haluska, BA Short, L Marwick, TH Univ Queensland Brisbane Qld Australia

Background Latent left ventricular (LV) dysfunction in patients with valvular or myocardial disease may be identified by loss of contractile reserve (CR) at exercise echocardiography. Contraction in the LV longitudinal axis may be more sensitive than radial contraction to minor disturbances of LV function. We sought to determine whether tissue Doppler measurement of longitudinal function could be used to identify CR. Methods Exercise echocardiography was performed in 86 patients (20 women, age 53 +/- 18 years), 72 with asymptomatic or minimally symptomatic mitral regurgitation, and 14 normal controls. Pulsed-wave tissue Doppler imaging (DTI) was used to measure maximum annular systolic velocity at rest and stress. Inducible ischemia was excluded by analysis of wall motion by an experienced observer. CR was defined by greater than or equal to5% improvement of stress compared with rest ejection fraction (EF). Exercise capacity was assessed from expired gas analysis. Results CR was present in 34 patients with mitral regurgitation (47%);peak EF in patients with and without CR was 74% +/- 11% versus 54% +/- 15% (P <.0001). CR could not be predicted by resting EF, volumes or sphericity, and DTI measurement of base-apex function was the only resting echocardiographic parameter to distinguish between patients with and without CR (10 +/- 2 vs 8 +/- 2 cm/s, P <.03). This parameter showed greater differences after stress (14 +/- 4 vs 11 +/- 3 cm/s, P <.001). Patients with CR showed lower peak DTI than controls, as well as lower exercise capacity and EF response to exercise. In a multiple linear regression model, rest DTI (P =.03) was an independent correlate of contractile reserve. The other correlates were age (P <.0001), resting (P <.0001) and peak end-systolic volume (P =.01), and resting (P <.0001) and peak end-diastolic volume (P <.0001);the model r(2) was 0.93 (P <.001). Conclusion In the absence of regional LV dysfunction, measurement of longitudinal axis function by DT

关键词：方差分析心排血量病例对照研究超声心动描记术运动试验二尖瓣闭锁不全/病理生理学二尖瓣闭锁不全/超声检查心肌收缩/生理学 ROC曲线敏感性与特异性心室功能障碍左/病理生理学心室功能障碍左/超声检查心室功能左女(雌)性人类男(雄)性中年人

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Noninvasive measurement of cardiac output: Two methods compared in patients with mitral regurgitation

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ANGIOLOGY 1999年第2期50卷 95-101页

作者： van der Meer, NJM Noordegraaf, AV Kamp, O de Vries, PMJM Univ Amsterdam Acad Med Ctr Dept Anesthesiol NL-1105 AZ Amsterdam Netherlands Vrije Univ Amsterdam Acad Hosp Dept Med Phys Amsterdam Netherlands Vrije Univ Amsterdam Acad Hosp Dept Pulm Med Amsterdam Netherlands Vrije Univ Amsterdam Acad Hosp Dept Cardiol Amsterdam Netherlands

In search for the origin of the less reliable cardiac output (CO) estimations by means of electrical impedance cardiography (EIC), the authors hypothesized that cardiac valve pathology might be one of the reasons. Twenty-six patients were examined by means of echo Doppler (ED) and EIC. The cardiac valve status was obtained by means of echocardiography and color Doppler flow, while CO was obtained by means of both methods. Seventeen patients had no valve pathology (nVP) while nine patients had mild to moderate mitral regurgitation (MVR). The overall correlation between the calculation of CO by means of the two methods was good (r = 0.85, p < 0.001, mean difference and standard deviation: 0.20 +/- 0.74 L/min), while there was no significant difference between the paired values. After division into an nVP and an MVR population, the results showed an even closer agreement between the CO values in the nVP population (r = 0.88, p < 0.001, mean difference and standard deviation: 0.15 +/- 0.68 L/min). Furthermore, significant differences were found in the first derivative of the impedance (dZ/dt) signals of these groups. Although the agreement between ED and EIC was slightly lower in the MVR population, EIC reliably estimated CO, even in case of MVR. The impedance signal itself gave an indication for the existence of MVR.

关键词：主动脉瓣关闭不全/病理生理学主动脉瓣关闭不全/超声检查心排血量/生理学心动描记术阻抗/方法超声心动描记术多普勒超声心动描记术多普勒彩色心率/生理学线性模型二尖瓣/病理生理学二尖瓣/超声检查二尖瓣闭锁不全/分类二尖瓣闭锁不全/病理生理学二尖瓣闭锁不全/超声检查可重复性结果每搏输出量/生理学三尖瓣闭锁不全/病理生理学三尖瓣闭锁不全/超声检查心室功能左/生理学成年人老年人老年人 80以上女(雌)性人类男(雄)性中年人

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The mitral regurgitation index: An echocardiographic guide to severity

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JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 1999年第7期33卷 2016-2022页

作者： Thomas, L Foster, E Hoffman, JIE Schiller, NB Univ Calif San Francisco Div Cardiol San Francisco CA 94143 USA

OBJECTIVES The purpose of this study was to develop a semiquantitative index of mitral regurgitation severity suitable for use in daily clinical practice and research. BACKGROUND There is no simple method for quantification of mitral regurgitation (MR). The MR Index is a semiquantitative guide to MR severity. The MR Index is a composite of six echocardiographic variables: color Doppler regurgitant jet penetration and proximal isovelocity surface area, continuous wave Doppler characteristics of the regurgitant jet and tricuspid regurgitant jet-derived pulmonary artery pressure, pulse wave Doppler pulmonary venous flow pattern and two-dimensional echocardiographic estimation of left atrial size. METHODS Consecutive patients (n = 103) with varying grades of MR, seen in the Adult Echocardiography Laboratory at UCSF, were analyzed retrospectively. All patients were evaluated for the six variables, each variable being scored on a four point scale from 0 to *** reference standards for MR were qualitative echocardiographic evaluation by an expert and quantitation of regurgitant fraction using two-dimensional and Doppler echocardiography. A subgroup of patients with low ejection fraction (EF <50%) were also analyzed. RESULTS The MR Index increased in proportion to MR severity with a significant difference among the three grades in both normal and low EF groups (F = 130 and F = 42, respectively, p < 0.0001). The MR Index correlated with regurgitant fraction (r 0.76, p < 0.0001). An MR Index greater than or equal to 2.2 identified 26/29 patients with severe MR (sensitivity = 90%, specificity = 88%, PPV = 79%). No patient with severe MR had an MR Index <1.8 and no patient with mild MR had an MR Index >1.7. CONCLUSIONS The MR Index is a simple semiquantitative estimate of MR severity, which seems to be useful in evaluating MR in patients with a low EF. (C) 1999 by the American College of Cardiology.

关键词：血流速度超声心动描记术多普勒彩色二尖瓣闭锁不全/诊断显像二尖瓣闭锁不全/病理生理学观察者偏差试验预期值肺楔压回顾性研究疾病严重程度指数每搏输出量成年人老年人老年人 80以上女(雌)性人类男(雄)性中年人

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