Lester S J, McElhinney D B, Miller J P, Lutz J T, Otto C M, Redberg R F
University of California San Francisco, Department of Medicine, Division of Cardiology, USA.
Circulation. 2000 Apr 25;101(16):1947-52. doi: 10.1161/01.cir.101.16.1947.
The ability to predict the rate of hemodynamic progression in an individual patient with valvular aortic stenosis has been elusive. The purpose of the present study was to evaluate whether the rate of change in aortic valve area (AVA) measured during the ejection phase of a cardiac cycle predicts the rate of hemodynamic progression in patients with asymptomatic aortic stenosis.
In 84 adults with initially asymptomatic aortic stenosis and a baseline AVA of > or =0.9 cm(2), annual echocardiographic data were obtained prospectively (mean follow-up 2.8+/-1.3 years). With the initial echocardiogram, the ratio of AVA measured at mid-acceleration and mid-deceleration to the AVA at peak velocity was calculated. The primary outcome variable was the annual rate of change in AVA (rate of progression), with rate of progression classified as rapid (a reduction in AVA of > or =0.2 cm(2)/y) or slow (<0.2 cm(2)/y). Rapid progression was significantly associated with an AVA ratio of > or =1.25 (P=0.004, risk ratio 3.1, 95% CI 1.2 to 7.9). The sensitivity, specificity, and positive predictive value of AVA ratio of > or =1.25 for the prediction o rapid progression of valvar aortic stenosis was 64%, 72%, and 80% respectively. The decrease in ejection fraction measured from the initial to final echocardiogram was small but greater for patients with an AVA ratio of > or =1.25 (-4+/-7% versus +2+/-7%, P<0.001).
A flow-dependent change in AVA can be measured during a routine transthoracic echocardiographic study. The rate of change in AVA is an additional measure of disease severity and may be used to predict an individual's risk for subsequent rapid disease progression.
预测个体瓣膜性主动脉瓣狭窄患者血流动力学进展速率的能力一直难以实现。本研究的目的是评估在心动周期射血期测量的主动脉瓣面积（AVA）变化率是否能预测无症状主动脉瓣狭窄患者的血流动力学进展速率。
对84例初始无症状且基线AVA≥0.9 cm²的成年人进行前瞻性研究，每年获取超声心动图数据（平均随访2.8±1.3年）。通过首次超声心动图，计算加速中期和减速中期测量的AVA与峰值流速时AVA的比值。主要结局变量是AVA的年变化率（进展速率），进展速率分为快速（AVA减少≥0.2 cm²/年）或缓慢（<0.2 cm²/年）。快速进展与AVA比值≥1.25显著相关（P = 0.004，风险比3.1，95%CI 1.2至7.9）。AVA比值≥1.25预测瓣膜性主动脉瓣狭窄快速进展的敏感性、特异性和阳性预测值分别为64%、72%和80%。从首次到末次超声心动图测量的射血分数下降虽小，但AVA比值≥1.25的患者下降幅度更大（-4±7%对+2±7%，P<0.001）。
在常规经胸超声心动图检查中可测量AVA的血流依赖性变化。AVA变化率是疾病严重程度的额外指标，可用于预测个体后续疾病快速进展的风险。
