Florath Ines, Albert Alexander, Rosendahl Ulrich, Ennker Ina Carolin, Ennker Jrgen
Heart Institute Lahr/Baden, Lahr, Germany.
Am Heart J. 2008 Jun;155(6):1135-42. doi: 10.1016/j.ahj.2007.12.037.
The impact of valve prosthesis-patient mismatch on long-term outcome after aortic valve replacement estimated by various variables such as projected indexed effective orifice area and internal geometric orifice area obtained from in vivo or in vitro published data is still controversial.
The effective orifice area was measured by echocardiography in 533 patients. The mean age of the patients was 71 +/- 9 years; mean follow-up time was 4.7 +/- 2.2 years. The impact of severe (indexed effective orifice area <or=0.6 cm(2)/m(2)) and moderate mismatch (0.6 cm(2)/m(2) < indexed effective orifice area <or=0.85 cm(2)/m(2)) on survival was evaluated by Cox regression.
Severe mismatch (hazard ratio: 1.9 [1.08-3.21]) was a significant predictor of survival time after adjustment for age, left ventricular ejection fraction, atrial fibrillation, New York Heart Association class, serum creatinine, and hemoglobin level. The 5- and 7-year survival rates were 71% +/- 4% and 54% +/- 8% for patients with severe mismatch and 83% +/- 4% and 80% +/- 8% for patients with mild mismatch, respectively. The correlation between projected and measured indexed effective orifice area was of medium strength (r = 0.49), and the frequency of observed mismatch depended linearly on the projected indexed effective orifice area. Although projected indexed effective orifice area and indexed internal geometric orifice area were significant predictors of severe mismatch, the sensitivity and specificity for severe prosthesis-patient mismatch were only 75% and 52%, using an optimal threshold of projected indexed effective orifice area defined by the Youden index.
Severe prosthesis-patient mismatch estimated by effective orifice area measured within 10 days was an independent risk factor of survival time. Projected indexed effective orifice area determined at surgery does not sufficiently predict mismatch.
通过诸如从体内或体外已发表数据获得的预计指数化有效瓣口面积和内部几何瓣口面积等各种变量来评估瓣膜假体-患者不匹配对主动脉瓣置换术后长期结局的影响仍存在争议。
通过超声心动图测量了533例患者的有效瓣口面积。患者的平均年龄为71±9岁；平均随访时间为4.7±2.2年。通过Cox回归评估严重（指数化有效瓣口面积≤0.6 cm²/m²）和中度不匹配（0.6 cm²/m²＜指数化有效瓣口面积≤0.85 cm²/m²）对生存的影响。
在对年龄、左心室射血分数、心房颤动、纽约心脏协会分级、血清肌酐和血红蛋白水平进行校正后，严重不匹配（风险比：1.9 [1.08 - 3.21]）是生存时间的显著预测因素。严重不匹配患者的5年和7年生存率分别为71%±4%和54%±8%，轻度不匹配患者分别为83%±4%和80%±8%。预计指数化有效瓣口面积与测量的指数化有效瓣口面积之间的相关性为中等强度（r = 0.49），观察到的不匹配频率与预计指数化有效瓣口面积呈线性相关。尽管预计指数化有效瓣口面积和指数化内部几何瓣口面积是严重不匹配的显著预测因素，但使用由约登指数定义的预计指数化有效瓣口面积的最佳阈值时，严重瓣膜假体-患者不匹配的敏感性和特异性仅为75%和52%。
在10天内测量的有效瓣口面积估计的严重瓣膜假体-患者不匹配是生存时间的独立危险因素。手术时确定的预计指数化有效瓣口面积不能充分预测不匹配情况。
