DETERMINATION OF AORTIC-VALVE AREA BY 2-DIMENSIONAL AND DOPPLER ECHOCARDIOGRAPHY IN PATIENTS WITH NORMAL AND STENOTIC BIOPROSTHETIC VALVES
DETERMINATION OF AORTIC-VALVE AREA BY 2-DIMENSIONAL AND DOPPLER ECHOCARDIOGRAPHY IN PATIENTS WITH NORMAL AND STENOTIC BIOPROSTHETIC VALVES
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DOI：
10.1016/0735-1097(90)90280-3
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发表时间：
1990-03-15
影响因子：
24
通讯作者：
TEAGUE, SM
中科院分区：
文献类型：
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作者：
ROTHBART, RM;CASTRIZ, JL;TEAGUE, SM
为了评估通过二维和多普勒超声心动图测量确定生物假体主动脉价值面积的可行性和准确性，我们从55例具有这种生物假体瓣膜和充分的多普勒研究的患者中选择了三个部分重叠的组。第1,37组近期主动脉瓣置换术且无瓣膜功能障碍临床或超声心动图证据的患者；2组12例经心导管置换术证实的人工瓣膜狭窄；第3组22名同时进行多普勒和导管检查的患者，可以直接比较无创和有创主动脉瓣面积测定。通过二维静止帧图像测量左心室流出道直径。通过脉冲和连续波多普勒谱测定主动脉瓣近端血流速度、跨瓣血流速度和加速时间。采用改进的伯努利方程计算主动脉瓣梯度，采用连续性方程计算主动脉瓣面积。在37例瓣膜功能正常的患者中，计算出的平均梯度范围为5 ~ 25mmhg（平均13.6±±）。5.2)和阀门面积从1.0到2.3平方厘米(平均1.6。0.31)。多普勒成像和心导管测量的人工主动脉瓣面积线性回归分析表明，两种技术之间存在高度相关性（r = 0.93）。人工瓣膜狭窄患者与非人工瓣膜狭窄患者的平均梯度（42.8 .+-）比较，差异有统计学意义。12.3比13.6。5.2 mm Hg；P = 0.0001)，加速时间(116 .+-。15比80 +-。13女士;P = 0.0001)，阀面积由连续性方程(0.80 .+-。0.16 vs . 1.6。0.31平方厘米;P = 0.0001)。评估单个超声变量在识别生物瓣膜狭窄中的效用。当选择诊断标准以保持绝对特异性时，异常高的平均梯度或无创确定的瓣膜面积< 1 cm2可识别92%的瓣膜狭窄患者。轻微降低的灵敏度与峰值梯度升高或加速时间延长有关；两组分别确定了75%的瓣膜狭窄患者。然而，测量左心室流出道与经瓣速度时间积分的比值进一步提高了诊断的准确性。37例假体瓣膜正常的患者的瓣膜比率均为bb0.35，而瓣膜狭窄的12例患者的瓣膜比率均较低。综上所述，心脏超声评估人工主动脉瓣面积具有较高的准确性，可用于生物人工主动脉瓣狭窄的诊断。
To assess the feasibility and accuracy of determining bioprosthetic aortic value area from two-dimensional and Doppler echocardiographic measurements, three partially overlapping groups were selected from 55 patients with such bioprosthetic valves and adequate Doppler studies. These were Group 1, 37 patients with recent aortic valve replacement surgery and no clinical or echocardiographic evidence of valve dysfuncton; Group 2, 12 patients with prosthetic valve stenosis documented by cardiac catheterization; and Group 3, 22 patients with both Doppler and catheterization studies in whom noninvasive and invasive determinations of aortic valve area could be directly compared. Left ventricular outflow tract diameter was measured from two-dimensional still frame images. Flow velocity proximal to the aortic valve, transvalvular velocity and acceleration time were determined from pulsed and continuous wave Doppler spectra. Aortic valve gradient was calculated with the modified Bernoulli equation and valve area by the continuity equation. In the 37 patients with a normally functioning valve, the calculated mean gradient ranged from 5 to 25 mm Hg (average 13.6 .+-. 5.2) and valve area from 1.0 to 2.3 cm2 (mean 1.6 .+-. 0.31). Linear regression analysis of prosthetic aortic valve area determined by Doppler imaging and cardiac catheterization demonstrated a high correlation (r = 0.93) between the two techniques. Comparison of the patients with and without prosthetic valve stenosis revealed statistically significant differences in mean gradient (42.8 .+-. 12.3 versus 13.6 .+-. 5.2 mm Hg; p = 0.0001), acceleration time (116 .+-. 15 versus 80 .+-. 13 ms; p = 0.0001) and valve area by the continuity equation (0.80 .+-. 0.16 versus 1.6 .+-. 0.31 cm2; p = 0.0001). Individual ultrasound variables were assessed for their utility in recognizing bioprosthetic valve stenosis. When diagnostic criteria were selected to maintain absolute specificity, either an abnormally high mean gradient or a noninvasively determined valve area < 1 cm2 identified 92% of patients with a stenotic valve. Marginally lower sensitivity was associated with an elevated peak gradient or a prolonged acceleration time; each identified 75% of the patients with valve stenosis. However, measurement of the ratio of left ventricular outflow tract to transvalvular velocity time integrals further improved diagnostic accuracy. All 37 patients with a normal prosthetic valve had a ratio > 0.35, whereas each of the 12 patients with valve stenosis had a lower ratio. In conclusion, assessment of prosthetic aortic valve area by cardiac ultrasound is highly accurate and can be useful in the diagnostic of bioprosthetic aortic valve stenosis.