Characterisation of aortic stenosis severity: a retrospective analysis of echocardiography reports in a clinical laboratory.
Characterisation of aortic stenosis severity: a retrospective analysis of echocardiography reports in a clinical laboratory.
复制标题
主动脉瓣狭窄严重程度的表征：临床实验室超声心动图报告的回顾性分析。
DOI：
10.1136/openhrt-2020-001331
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发表时间：
2020
期刊：
影响因子：
2.7
通讯作者：
Merryman,WDavid
中科院分区：
文献类型：
--
作者：
Raddatz,MichaelA;Gonzales,HollyM;Farber-Eger,Eric;Wells,QuinnS;Lindman,BrianR;Merryman,WDavid
目的探讨主动脉瓣狭窄（AS）超声心动图常用指标对重度AS患者瓣膜置换率的影响。方法回顾性分析2005年1月~ 2006年12月主动脉瓣口面积（AVA）≤ 1.2cm 2、峰值血流速度（Vmax）≥3 m/s的超声心动图资料，并与2005年1月~ 2006年12月主动脉瓣口面积（AVA）≤ 1.2cm 2、峰值血流速度（Vmax）≥3 m/s的患者进行比较。s从2014年12月1日至2017年10月30日在一个单一的学术医疗中心。结果在807例AVA ≤ 1.2cm 2和Vmax≥3 m/s的患者中（44.0%为女性，中位年龄74岁（IQR：66-81）），45.6%的患者Vmax≥4 m/s，75.8%的患者AVA ≤ 1cm 2。40.0%的患者具有重度AS的一致性指标（Vmax≥4 m/s和AVA ≤1 cm 2），35.8%的患者具有重度AS的不一致性指标（Vmax<4 m/s和AVA ≤1 cm 2）。与具有一致指数的患者相比，具有不一致指数的患者更常见于女性（54.0% vs 44.3%，p<0.05），并且不太常见于重度患者（42.6% vs 93.8%，p<0.001）。矛盾的低流量，低梯度严重AS患者的超声心动图不成比例的女性（61.5%比41.8%，p<0.001），他们的疾病的特点是严重的只有49.5%of the time.ConclusionsPatients with discordant indices，谁是不成比例的女性，通常在临床超声心动图报告中被描述为具有小于严重AS。考虑到AVR在AVA ≤1 cm 2的患者中的潜在受益，无论Vmax如何，这可能具有重要的临床意义。
ObjectiveTo evaluate how common echocardiographic metrics of aortic stenosis (AS) influence the proportion of patients who may be categorised as having severe stenosis and therefore considered for valve replacement.MethodsRetrospective analysis was performed of all echocardiograms with aortic valve area (AVA) ≤1.2 cm2and peak jet velocity (Vmax) ≥3 m/s from 1 December 2014 through 30 October 2017 at a single academic medical centre. Echocardiographic indices collected include AVA, Vmax, left ventricular ejection fraction, stroke volume and annotated aortic stenosis severity.ResultsAmong 807 patients with AVA ≤1.2 cm2and Vmax≥3 m/s (44.0% female, median age 74 years (IQR: 66–81)), 45.6% had Vmax≥4 m/s, while 75.8% had AVA ≤1 cm2. 40.0% of patients had concordant indices (Vmax≥4 m/s and AVA ≤1 cm2), and 35.8% had discordant indices (Vmax<4 m/s and AVA ≤1 cm2) of severe AS. Compared with those with concordant indices, patients with discordant indices were more commonly female (54.0% vs 44.3%, p<0.05) and less commonly characterised as severe (42.6% vs 93.8%, p<0.001). Patients with paradoxical low-flow, low-gradient severe AS by echocardiography were disproportionately female (61.5% vs 41.8%, p<0.001), and their disease was characterised as severe only 49.5% of the time.ConclusionsPatients with discordant indices, who are disproportionately female, are commonly described in clinical echocardiography reports as having less than severe AS. Given the potential benefit of AVR in patients with AVA ≤1 cm2regardless of Vmax, this could have important clinical implications.