Berglund H, Kim C J, Nishioka T, Luo H, Siegel R J
Division of Cardiology, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA 90048, USA.
Echocardiography. 2001 Jan;18(1):65-72. doi: 10.1046/j.1540-8175.2001.00065.x.
To examine the influence of left ventricular dysfunction, aortic regurgitation, and mitral regurgitation on commonly used methods for aortic valve area (AVA) determination.
Each method for AVA determination has its inherent limitations.
AVA determinations by transesophageal echocardiography (TEE) using planimetry, transthoracic echocardiography (TTE) with application of the continuity equation, and cardiac catheterization applying the Gorlin formula were performed in 74 patients with aortic stenosis. The severity of the aortic stenosis was defined by consensus of at least two methods. Over- or underestimation of AVA associated with ejection fraction, aortic regurgitation, mitral regurgitation, or severity of the aortic stenosis for each method in relation to the other two methods was assessed.
Mean AVAs were 1.05 +/- 0.51 by TEE, 1.06 +/- 0.51 by TTE, and 1.08 +/- 0.53 by cardiac catheterization. An overestimation of the severity of the aortic stenosis by the Gorlin formula in patients with moderate-to-severe aortic regurgitation as compared to TEE-derived data was found (P = 0.014). A similar trend of overestimation by catheterization in comparison with the TTE data was found. In the context of moderate-to-severe mitral regurgitation, AVA determination by TTE overestimated the degree of aortic stenosis as compared to TEE (P = 0.011) and cardiac catheterization (P = 0.023).
Overall mean AVA did not differ between methods, suggesting that these three methods are equally accurate in a nonselected clinical patient group. However, in the presence of significant aortic regurgitation, the two echocardiographic methods appear more accurate. Our observation of an overestimation of the severity of aortic stenosis by TTE in the presence of moderate-to-severe mitral regurgitation indicates that this possibility should be accounted for in clinical decisions based on TTE determinations of AVA.
探讨左心室功能不全、主动脉瓣反流及二尖瓣反流对常用主动脉瓣面积（AVA）测定方法的影响。
每种AVA测定方法都有其固有的局限性。
对74例主动脉瓣狭窄患者进行经食管超声心动图（TEE）面积测定法、应用连续方程的经胸超声心动图（TTE）以及应用戈林公式的心导管检查。主动脉瓣狭窄的严重程度由至少两种方法共同确定。评估每种方法相对于其他两种方法在与射血分数、主动脉瓣反流、二尖瓣反流或主动脉瓣狭窄严重程度相关的AVA高估或低估情况。
TEE测得的平均AVA为1.05±0.51，TTE测得的平均AVA为1.06±0.51，心导管检查测得的平均AVA为1.08±0.53。与TEE得出的数据相比，发现中度至重度主动脉瓣反流患者中戈林公式高估了主动脉瓣狭窄的严重程度（P = 0.014）。与TTE数据相比，心导管检查也有类似的高估趋势。在中度至重度二尖瓣反流情况下，与TEE（P = 0.011）和心导管检查（P = 0.023）相比，TTE测定的AVA高估了主动脉瓣狭窄程度。
各方法之间总体平均AVA无差异，表明这三种方法在未选择的临床患者群体中准确性相当。然而，在存在显著主动脉瓣反流时，两种超声心动图方法似乎更准确。我们观察到在存在中度至重度二尖瓣反流时TTE高估了主动脉瓣狭窄的严重程度，这表明在基于TTE测定AVA的临床决策中应考虑到这种可能性。
