Almeida Ana G, Sargento Luís, Gabriel Henrique M, da Costa J Marques, Morais José, Madeira Francisco, David Cláudio, Oliveira Joaquim, da Cunha J Correia, Vagueiro M Celeste
Serviço de Cardiologia do Hospital de Santa Maria, Clínica Universitária de Cardiologia da Faculdade de Medicina de Lisboa.
Rev Port Cardiol. 2002 May;21(5):555-72.
To evaluate the role of contrast Doppler echocardiography in the assessment of aortic stenosis severity, in comparison with the conventional method and using the catheterization study as the gold standard.
Prospective comparative study.
Echocardiography Laboratory of Cardiology Department.
We included 36 consecutive patients, 20 male, aged 67 +/- 11 years, referred for catheterization study to evaluate aortic stenosis severity.
All patients underwent conventional and contrast Doppler echocardiography and catheterization study. For contrast Doppler, we used Levovist (300 mg/ml infusion). We analyzed the following echocardiographic parameters: a) left ventricle dimensions, wall thickness and function; b) aortic valve morphology; c) post-stenotic aortic valve flow--peak velocity, velocity-time integral, peak gradient, mean gradient; d) left ventricle outflow tract flow--peak velocity, velocity-time integral; e) aortic valve functional area; f) acquisition time and Doppler signal intensity for post-stenotic aortic valve flow. Catheterization parameters analyzed: a) peak aortic valve gradient; b) mean aortic valve gradient.
Contrast Doppler yielded higher peak gradients than conventional Doppler (85.6 +/- 30.2 vs 72.6 +/- 26.1 mmHg, p < 0.001), as well as higher mean gradients (51.4 +/- 19.0 vs 44.2 +/- 15.9 mmHg, p < 0.001). Peak gradients obtained with contrast Doppler correlated with those obtained invasively (r = 0.88, p < 0.001), although the values were higher (85.6 +/- 30.2 vs 73.6 +/- 32.0 mmHg, p < 0.001). There was no difference between mean contrast Doppler gradients and mean catheterization gradients, which showed a high correlation (r = 0.89, p < 0.001). There was no difference between peak and mean gradients obtained by conventional Doppler and invasively, which yielded correlations of 0.73 and 0.75, respectively (p < 0.001). The sensitivity of contrast Doppler for detection of severe aortic stenosis was 100% for peak gradient and 84% for mean gradient, while for conventional Doppler it was 68% and 58%. The specificity of contrast Doppler was 65% for peak gradient and 88% for mean gradient, while for conventional Doppler it was, respectively, 58% and 88%. Acquisition time for aortic flow visualization was lower (p < 0.001) and flow intensity higher for contrast Doppler, in comparison with conventional Doppler.
In this study, contrast Doppler yielded high correlations with invasive data and higher sensitivity and specificity for detection of severe aortic stenosis than conventional Doppler. It is a useful method for evaluation of aortic stenosis severity.
与传统方法相比，并以心导管检查作为金标准，评估对比剂多普勒超声心动图在评估主动脉瓣狭窄严重程度中的作用。
前瞻性对比研究。
心内科超声心动图实验室。
我们纳入了36例连续患者，其中男性20例，年龄67±11岁，因评估主动脉瓣狭窄严重程度而接受心导管检查。
所有患者均接受传统及对比剂多普勒超声心动图检查和心导管检查。对于对比剂多普勒检查，我们使用了声诺维（300mg/ml静脉注射）。我们分析了以下超声心动图参数：a）左心室大小、室壁厚度及功能；b）主动脉瓣形态；c）狭窄后主动脉瓣血流——峰值速度、速度时间积分、峰值压差、平均压差；d）左心室流出道血流——峰值速度、速度时间积分；e）主动脉瓣功能面积；f）狭窄后主动脉瓣血流的采集时间及多普勒信号强度。分析的心导管检查参数：a）主动脉瓣峰值压差；b）主动脉瓣平均压差。
对比剂多普勒检查得出的峰值压差高于传统多普勒检查（85.6±30.2 vs 72.6±26.1mmHg，p<0.001），平均压差也更高（51.4±19.0 vs 44.2±15.9mmHg，p<0.001）。对比剂多普勒检查得出的峰值压差与有创检查得出的峰值压差相关（r=0.88，p<0.001），尽管数值更高（85.6±30.2 vs 73.6±32.0mmHg，p<0.001）。对比剂多普勒平均压差与心导管检查平均压差之间无差异，二者相关性较高（r=0.89，p<0.001）。传统多普勒检查得出的峰值和平均压差与有创检查得出的结果之间无差异，相关性分别为0.73和0.75（p<0.001）。对比剂多普勒检查检测重度主动脉瓣狭窄的峰值压差敏感性为100%。平均压差敏感性为84%，而传统多普勒检查的敏感性分别为68%和58%。对比剂多普勒检查的峰值压差特异性为65%，平均压差特异性为88%，而传统多普勒检查的特异性分别为58%和88%。与传统多普勒检查相比，对比剂多普勒检查的主动脉血流可视化采集时间更短（p<0.001），血流信号强度更高。
在本研究中，对比剂多普勒检查与有创检查数据具有高度相关性，且检测重度主动脉瓣狭窄的敏感性和特异性高于传统多普勒检查。它是评估主动脉瓣狭窄严重程度的一种有用方法。
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