Magnetic resonance imaging versus echocardiography to ascertain the regression of left ventricular hypertrophy after bioprosthetic aortic valve replacement: Results of the REST study
Magnetic resonance imaging versus echocardiography to ascertain the regression of left ventricular hypertrophy after bioprosthetic aortic valve replacement: Results of the REST study
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DOI：
10.1016/j.jtcvs.2011.11.017
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发表时间：
2012-09-01
影响因子：
6
通讯作者：
Gerosa, Gino
中科院分区：
文献类型：
--
作者：
Breitenbach, Ingo;Harringer, Wolfgang;Gerosa, Gino
目的：比较采用Epic和Epic Supra带支架猪生物瓣膜行主动脉瓣置换术（AVR）治疗重度主动脉瓣狭窄后，通过磁共振成像（MRI）与经胸超声心动图（TTE）测量的左心室质量指数（LVMI）降低情况（St Jude Medical，Inc，St Paul，Minn）。这项前瞻性多中心研究入组了149例在2006年1月至2008年2月期间接受AVR的患者。在基线和6个月随访时进行TTE和心脏MRI测量LVMI，并进行比较。结果：TTE测量的LVMI值比MRI测量值高48%~ 63%。通过TTE测量，Epic瓣膜的LVMI从137 +/- 32降至95 +/- 16 g/m2，Epic Supra瓣膜的LVMI从139 +/- 29降至104 +/- 28 g/m2（两种比较均P < .0001）。心脏MRI显示，Epic和Epic Supra瓣膜的LVMI分别从84 +/- 20降至64 +/- 12 g/m（2）和从86 +/- 27降至64 +/- 17 g/m（2）（两种比较均P < .0001）。TTE显示Epic的平均压差从51.6 +/- 15.3 mm Hg显著回归至15.5 +/- 5.2 mm Hg，Epic的平均压差从46.7 +/- 19.4 mm Hg回归至17.9 +/- 12.8 mm Hg（两种比较P <0.0001）结论：两种生物假体模型的所有尺寸在主动脉瓣置换术后均测得LVMI显著降低。由于Devereux公式高估了LVMI的降低，以及心脏MRI测量的更高准确性和可重复性，后者应优于TTE。本论文的最终验证只能做比较这些模式与病理检查。（《胸血管外科杂志》2012;144：640-5）
Objectives: To compare the decrease in left ventricular mass index (LVMI) by magnetic resonance imaging (MRI) versus transthoracic echocardiography (TTE) after aortic valve replacement (AVR) for severe aortic stenosis with Epic and Epic Supra stented porcine bioprostheses (St Jude Medical, Inc, St Paul, Minn).Methods: This prospective multicenter study enrolled 149 patients who underwent AVR between January 2006 and February 2008. TTE and cardiac MRI measurements of LVMI were made at baseline and at 6 months of follow-up and were compared. Changes in mean pressure gradients were examined using TTE.Results: TTE measurements of LVMI were 48% to 63% higher than the MRI measurements. A decrease in LVMI from 137 +/- 32 to 95 +/- 16 g/m(2) with the Epic and from 139 +/- 29 to 104 +/- 28 g/m(2) with the Epic Supra valves (P < .0001 for both comparisons) was measured by TTE. Cardiac MRI revealed decreases in LVMI from 84 +/- 20 to 64 +/- 12 g/m(2) and from 86 +/- 27 to 64 +/- 17 g/m(2) with the Epic and Epic Supra valves, respectively (P < .0001 for both comparisons). TTE revealed a significant regression of mean pressure gradients from 51.6 +/- 15.3 to 15.5 +/- 5.2 mm Hg with the Epic and from 46.7 +/- 19.4 to 17.9 +/- 12.8 mm Hg with the Epic supra (P < .0001 for both comparisons).Conclusions: A significant decrease in LVMI was measured after AVR with all sizes of both bioprosthetic models. Because of the overestimation of the decrease in LVMI by the Devereux formula, as well as the higher accuracy and reproducibility of cardiac MRI measurements, the latter should be preferred to TTE. An ultimate validation of this thesis could only be done comparing each of these modalities with pathologic examination. (J Thorac Cardiovasc Surg 2012;144:640-5)