Minners Jan, Allgeier Martin, Gohlke-Baerwolf Christa, Kienzle Rolf-Peter, Neumann Franz-Josef, Jander Nikolaus
Department of Cardiology, Herz-Zentrum Bad Krozingen, Suedring 15, 79189 Bad Krozingen, Germany.
Eur Heart J. 2008 Apr;29(8):1043-8. doi: 10.1093/eurheartj/ehm543. Epub 2007 Dec 22.
The present study tests the consistency of echocardiographic criteria for the grading of aortic valve stenosis.
Current guidelines/recommendations define severe stenosis as an aortic valve area (AVA) <1 cm2 (or <0.6 cm2 adjusted for body surface area), mean pressure gradient (DeltaPm) >40 mmHg, or peak flow velocity (Vmax) >4 m/s. We tested the consistency of the three criteria for the grading of aortic valve stenosis in 3483 echocardiography studies performed in 2427 patients with normal left ventricular (LV) systolic function and a calculated AVA of < or =2 cm2. We calculated curve fits for the relationship between AVA and DeltaPm using the Gorlin equation and between AVA and Vmax based on the continuity equation for our study population. An AVA of 1.0 cm2 correlated to a DeltaPm of 21 mmHg and a Vmax of 3.3 m/s. Conversely, a DeltaPm of 40 mmHg corresponds to an AVA of 0.75 cm2 and a Vmax of 4.0 m/s to an AVA of 0.82 cm2. Consequently, severe stenosis was diagnosed in 69% of patients based on AVA, 45% on Vmax, and 40% on DeltaPm. Stroke volume was lower in inconsistently graded patients (65 +/- 11 mL vs. consistently graded: 70 +/- 14 mL, P < 0.001).
The criteria for the grading of aortic stenosis are inconsistent in patients with normal systolic LV function. On the basis of AVA, a higher proportion of patients is classified as having severe aortic valve stenosis compared with mean pressure gradient and peak flow velocity. Discrepant grading in these patients may be partly due to reduced stroke volume.
本研究检测超声心动图评估主动脉瓣狭窄分级标准的一致性。
当前指南/推荐将严重狭窄定义为主动脉瓣面积（AVA）<1平方厘米（或根据体表面积调整后<0.6平方厘米）、平均压力阶差（ΔPm）>40毫米汞柱或峰值流速（Vmax）>4米/秒。我们在2427例左心室（LV）收缩功能正常且计算得出的AVA≤2平方厘米的患者中进行的3483项超声心动图研究中，检测了这三项主动脉瓣狭窄分级标准的一致性。我们使用戈林方程计算AVA与ΔPm之间的曲线拟合，并根据连续性方程计算AVA与Vmax之间的曲线拟合，用于我们的研究人群。1.0平方厘米的AVA对应21毫米汞柱的ΔPm和3.3米/秒的Vmax。相反，40毫米汞柱的ΔPm对应0.75平方厘米的AVA，4.0米/秒的Vmax对应0.82平方厘米的AVA。因此，根据AVA诊断为严重狭窄的患者占69%，根据Vmax诊断的占45%，根据ΔPm诊断的占40%。分级不一致的患者每搏输出量较低（65±11毫升，而分级一致的患者为70±14毫升，P<0.001）。
左心室收缩功能正常的患者中，主动脉狭窄的分级标准不一致。基于AVA，与平均压力阶差和峰值流速相比，有更高比例的患者被归类为患有严重主动脉瓣狭窄。这些患者分级不一致可能部分归因于每搏输出量减少。
