Methodologic issues in clinical evaluation of stenosis severity in adults undergoing aortic or mitral balloon valvuloplasty. The NHLBI Balloon Valvuloplasty Registry.
Methodologic issues in clinical evaluation of stenosis severity in adults undergoing aortic or mitral balloon valvuloplasty. The NHLBI Balloon Valvuloplasty Registry.
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接受主动脉或二尖瓣球囊成形术的成人狭窄严重程度临床评估的方法学问题。
DOI：
10.1016/0002-9149(92)90712-8
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发表时间：
1992
期刊：
影响因子：
--
通讯作者：
Bonan,R
中科院分区：
文献类型：
--
作者：
Otto,CM;Davis,KB;HolmesJr,DR;O'Neill,W;Ferguson,J;Bashore,TM;Bonan,R
尽管导管和多普勒测量瓣膜狭窄严重程度的方法已经得到验证，但每种方法都有特定的优点和局限性，特别是在球囊瓣膜成形术的设置上。将术前、术后即刻(n=589)或(n=608)二尖瓣导管球囊成形术前后测得的有创瓣膜面积和平均压力梯度与术前30天和术后24~72小时测得的平均压力梯度和有创瓣面积进行比较。多普勒和有创主动脉瓣面积相差0.5cm2占99%，≤相差0.2cm2占92%。导管球囊瓣膜成形术前后瓣膜面积(r=0.49 vs r=0.35，p=0.01)和平均压力梯度(r=0.64 vs r=0.50，p=0.01)均呈较高的线性相关。导管球囊瓣膜成形术前平均有创瓣膜面积较术前略小(0.50vs0.59cm2，p<；0.0001)，但术后差异无统计学意义(0.80vs0.78cm2，p=0.16)。影响瓣膜面积差异的变量包括心输出量、主动脉瓣返流、心率和血压。平均压差与二尖瓣回声质量、血压及二尖瓣返流有关，二尖瓣狭窄患者二尖瓣球囊成形术前二维超声心动图瓣膜面积范围为0.4~2.8cm2，术后二尖瓣面积为0.7~3.8cm2。二维超声心动图与有创二尖瓣面积相差0.5cm2者占96%，≤相差0.2cm2者占81%。二维超声心动图瓣膜面积(r=0.40 vs 0.36)、压力半衰期瓣膜面积(r=0.31 vs 0.32)、平均压力梯度(r=0.55 vs r=0.46)与导管球囊瓣膜成形术前后的线性相关无显著差异。平均二维超声心动图和压力半衰期瓣膜面积在瓣膜成形术前(1.09cm2比1.02cm2，p=0.001)大于有创瓣面积(1.71cm2比2.02cm2，p=0.0001)。影响差异的重要变量是二尖瓣返流、房间分流、心输出量和心率。非同步研究、不同的容量流量测量以及每种技术的潜在准确性是这些方法之间差异的主要原因。每种药物的临床应用将取决于其预测患者长期结果的能力。
Although both catheterization and Doppler measures of valvular stenosis severity have been validated, each has specific advantages and limitations, particularly in the setting of balloon valvuloplasty. Invasive valve area and mean pressure gradient recorded immediately before and after aortic (n = 589) or mitral (n = 608) catheter balloon valvuloplasty were compared with Doppler valve area and mean pressure gradient recorded <30 days before and 24 to 72 hours after the procedure.For aortic stenosis, Doppler valve area ranged from 0.1 to 1.4 cm2before and 0.2 to 2.3 cm2after catheter balloon valvuloplasty. Doppler and invasive aortic valve areas differed by ≤0.5 cm2in 99% and by <0.2 cm2in 92% of patients. Linear correlation was higher before versus after catheter balloon valvuloplasty, for both valve area (r = 0.49 vs r = 0.35, p = 0.01) and mean pressure gradient (r = 0.64 vs r = 0.50, p = 0.01). Group mean invasive valve area was slightly smaller before (0.50 vs 0.59 cm2, p < 0.0001) but was not different after (0.80 vs 0.78 cm2, p = 0.16) catheter balloon valvuloplasty. Variables affecting the valve area differences were cardiac output, aortic regurgitation, heart rate and blood pressure. Mean pressure gradient differences were related to echo quality, blood pressure and mitral regurgitation.For mitral stenosis, 2-dimensional echocardiographic valve area ranged from 0.4 to 2.8 cm2before and 0.7 to 3.8 cm2after catheter balloon valvuloplasty. Two-dimensional echocardiography and invasive mitral valve areas differed by ≤0.5 cm2in 96% and by <0.2 cm2in 81% of cases. Linear correlation was not different before versus after catheter balloon valvuloplasty for two-dimensional echocardiographic valve area (r = 0.40 vs 0.36), pressure halftime valve area (r = 0.31 vs 0.32) or mean pressure gradient (r = 0.55 vs r = 0.46). Group mean 2-dimensional echocardiography and pressure halftime valve areas were larger than invasive valve areas before (1.09 vs 1.02 cm2, p = 0.001) and smaller after (1.71 vs 2.02 cm2, p < 0.0001) catheter balloon valvuloplasty. Important variables affecting the differences were mitral regurgitation, interatrial shunt, cardiac output and heart rate.Nonsimultaneous studies, differing volume flow measurements, and the underlying accuracy of each technique largely account for discrepancies between these methods. The clinical use of each will depend on its ability to predict long-term patient outcome.
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影响因子：
4.2
作者：
D. Kulick;C. Reid;D. Kawanishi;S. Rahimtoola
通讯作者：
S. Rahimtoola
二维超声心动图和多普勒压力半时法在评估有或没有既往连合切开术的患者二尖瓣狭窄严重程度方面的比较准确性。
影响因子：
37.8
作者：
Mikel D. Smith;R. Handshoe;S. Handshoe;Ling Kwan;A. DeMaria
通讯作者：
A. DeMaria
根据无创超声多普勒数据和二尖瓣流速确定二尖瓣狭窄的有效孔口面积。
影响因子：
--
作者：
J. Holen;R. Aaslid;K. Landmark;S. Simonsen;T. Ostrem
通讯作者：
T. Ostrem
超声心动图评估老年主动脉瓣狭窄患者的主动脉瓣面积以及经皮球囊瓣膜成形术后瓣膜面积的变化。
影响因子：
24
作者：
P. Come;M. Riley;R. McKay;R. Safian
通讯作者：
R. Safian
验证连续波多普勒在实验诱发的主动脉瓣狭窄中测量的瞬时压力梯度。
影响因子：
2.8
作者：
Mark J. Callahan;A. Tajik;Su;Alfred A. Bove
通讯作者：
Alfred A. Bove