Prediction of postoperative performance in aortic valve disease.
Prediction of postoperative performance in aortic valve disease.
复制标题
主动脉瓣疾病术后表现的预测。
DOI：
10.1016/0002-9149(81)90610-x
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发表时间：
1981
期刊：
影响因子：
--
通讯作者：
Krayenbuehl,HP
中科院分区：
文献类型：
--
作者：
Mirsky,I;Henschke,C;Hess,OM;Krayenbuehl,HP
一种新的直接方法已被开发用于预测接受主动脉瓣置换术的患者的术后性能。采用微测压法和血管造影电影，对171例术前研究患者和44例术前和术后研究患者（14例作为对照组）的一些常规血流动力学和血管造影变量（包括心室压力一阶导数除以心室压力（dP/dt/P）max的峰值）进行了评价。正常收缩状态关系（dP/dt/P）max与舒张末期压（范围在15 mm Hg或更小至大于15 mm Hg）的关系来自术前射血分数和峰值室壁应力等于或大于对照组平均值-2标准差的患者。如果术前（dP/dt/P）max和舒张末期压低于这些收缩状态关系的95%置信区间，则预测术后功能异常（射血分数低于对照组平均值-2标准差）。这一结果得到了判别函数分析（基于术前射血分数，舒张末期压和[dP/dt/P]max）的证实，44例患者中有42例得到了正确的分类。这些研究表明，术前心肌收缩状态是主动脉瓣疾病术后表现的主要决定因素。
A new direct method has been developed for predicting postoperative performance in patients undergoing aortic valve replacement. Employing micromanometry and cineangiography, a number of conventional hemodynamic and angiographic variables, including the peak value of the first derivative of ventricular pressure divided by ventricular pressure (dP/dt/P)maxwere evaluated in 171 patients studied preoperatively and in 44 patients studied pre- and postoperatively with an additional 14 patients serving as control subjects. Normal contractile state relations (dP/dt/P)maxversus end-diastolic pressure (over a range of 15 mm Hg or less to more than 15 mm Hg) were derived from patients whose preoperative ejection fraction and peak wall'stress were equal to or more than control mean — 2 standard deviations. Postoperative function was predicted to be abnormal (ejection fraction less than control mean — 2 standard deviations) if preoperative values of (dP/dt/P)maxand enddiastolic pressure fell below the 95 percent confidence bands of these contractile state relations.The method accurately predicted postoperative function in 40 of 44 patients with a sensitivity of 100 percent. This result was confirmed by a discriminant function analysis (based on preoperative ejection fraction, end-diastolic pressure and [dP/dt/P]max) that yielded correct classifications in 42 of 44 patients. These studies indicate that the preoperative contractile state of the myocardium is the major determinant of postoperative performance in aortic valve disease.