Comparison of invasive and non-invasive pressure gradients in aortic arch obstruction.
Comparison of invasive and non-invasive pressure gradients in aortic arch obstruction.
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DOI：
10.1017/s1047951114002522
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发表时间：
2015-10
影响因子：
1
通讯作者：
Barker PC
中科院分区：
文献类型：
--
作者：
Wisotzkey BL;Hornik CP;Green AS;Barker PC
主动脉弓阻塞可以通过导管峰-峰压差或多普勒峰值瞬时压差来评估。先前的研究显示离散性缩窄有中度相关性，但很少有研究评估更复杂主动脉重建患者的相关性。我们对60例原发性/复发性缩窄或主动脉重建患者的心脏导管插入术和导管插入术前后的超声心动图进行了回顾性比较。主动脉弓阻塞定义为原发性/复发性缩窄患者的峰-峰压差≥25 mmHg，主动脉重建患者的峰-峰压差≥10 mmHg。在两组中，舒张期血流持续与主动脉弓阻塞无关。即使在心脏指数正常的患者中，多普勒峰值瞬时压力梯度（有和没有扩展伯努利方程）与峰-峰梯度也存在弱相关性（分别为r=0.36，p=0.016和r=0.49，p=0.001）。受试者工作特征曲线分析确定了所有类型梗阻患者的曲线下面积为0.61，45 mmHg的截止点正确分类了64%的足弓梗阻患者（灵敏度39%，特异性89%）。在心脏指数≥3 L/min/m2的主动脉弓重建患者中，23 mmHg的临界点正确分类了69%的患者（灵敏度为71%，特异性为50%），曲线下面积为0.82。主动脉阻塞的非侵入性评估仍然具有挑战性。在主动脉重建和正常心脏指数的患者中，多普勒指数的相关性最大。
Aortic arch obstruction can be evaluated by catheter peak-to-peak gradient or by Doppler peak instantaneous pressure gradient. Previous studies have shown moderate correlation in discrete coarctation, but few have assessed correlation in patients with more complex aortic reconstruction. We carried out retrospective comparison of cardiac catheterisations and pre- and post-catheterisation echocardiograms in 60 patients with native/recurrent coarctation or aortic reconstruction. Aortic arch obstruction was defined as peak-to-peak gradient ≥25 mmHg in patients with native/recurrent coarctation and ≥10 mmHg in aortic reconstruction. Diastolic continuation of flow was not associated with aortic arch obstruction in either group. Doppler peak instantaneous pressure gradient, with and without the expanded Bernoulli equation, weakly correlated with peak-to-peak gradient even in patients with a normal cardiac index (r=0.36, p=0.016, and r=0.49, p=0.001, respectively). Receiver operating characteristic curve analysis identified an area under the curve of 0.61 for patients with all types of obstruction, with a cut-off point of 45 mmHg correctly classifying 64% of patients with arch obstruction (sensitivity 39%, specificity 89%). In patients with aortic arch reconstruction who had a cardiac index ≥3 L/min/m2, a cut-off point of 23 mmHg correctly classified 69% of patients (71% sensitivity, 50% specificity) with an area under the curve of 0.82. The non-invasive assessment of aortic obstruction remains challenging. The greatest correlation of Doppler indices was noted in patients with aortic reconstruction and a normal cardiac index.