Schoen Steffen P, Zimmermann Till F, Rosenberger Charlotte, Elmer Gesa, Stolte Dirk, Wunderlich Carsten, Strasser Ruth H
Department of Cardiology and Intensive Care, Heart Center, University of Technology, Dresden, Fetscherstr. 76, 01307 Dresden, Germany.
Eur J Echocardiogr. 2009 Jun;10(4):532-6. doi: 10.1093/ejechocard/jen333. Epub 2009 Jan 20.
Continuity equation to evaluate aortic valve area (AVA(CE)) is critically dependent on accurate measurement of left ventricular outflow tract diameter and velocity. To circumvent these limitations, the present study aimed to generate nomograms for a facilitated estimation of aortic valve area using peak aortic valve pressure gradient (DeltapAv) and left ventricular ejection fraction (LVEF).
Two hundred and fifty-five subjects with non-invasively and invasively defined aortic valve stenosis (AS) formed the basis of this study. Basis of the nomograms was the correlation analysis between DeltapAv and AVA as estimated by AVA(CE) within different LVEF groups. LVEF differed from 65.6 +/- 1.8% (Group I, LVEF > 60%) to 34.5 +/- 4.3% (Group IV, LVEF > or = 30%). DeltapAv and AVA varied from 85.6 +/- 19.5 mmHg and 0.69 +/- 0.16 cm2 in Group I to 58.5 +/- 15.9 mmHg and 0.73 +/- 0.23 cm2 in Group IV (DeltapAv: P < 0.001). Mean AVA(CE) showed no significant difference between the groups. Correlation between DeltapAv and AVA(CE) was statistically significant with P < 0.001 in all subgroups (R2 between 0.72 and 0.76). Furthermore, a prospective estimation of AVA using the developed nomograms correlated very well with invasively determined AS using the Gorlin formula (R2 = 0.76, SEE = 0.21 cm2, bias 0.04 cm2).
The present study has established and confirmed a solid, easy to use nomogram-based method to accurately quantify severe AS.
连续性方程用于评估主动脉瓣面积（AVA(CE)）严重依赖于左心室流出道直径和速度的准确测量。为规避这些限制，本研究旨在生成诺模图，以便利用主动脉瓣峰值压力阶差（ΔpAv）和左心室射血分数（LVEF）来方便地估计主动脉瓣面积。
255例经非侵入性和侵入性诊断为主动脉瓣狭窄（AS）的受试者构成了本研究的基础。诺模图的基础是不同LVEF组内ΔpAv与AVA(CE)所估计的AVA之间的相关性分析。LVEF从65.6±1.8%（I组，LVEF>60%）到34.5±4.3%（IV组，LVEF≥30%）不等。ΔpAv和AVA在I组中分别为85.6±19.5 mmHg和0.69±0.16 cm²，在IV组中分别为58.5±15.9 mmHg和0.73±0.23 cm²（ΔpAv：P<0.001）。各组间平均AVA(CE)无显著差异。所有亚组中，ΔpAv与AVA(CE)之间的相关性均具有统计学意义（P<0.001），R²在0.72至0.76之间。此外，使用所开发的诺模图对AVA进行的前瞻性估计与使用戈林公式进行的侵入性确定的AS相关性非常好（R² = 0.76，标准误 = 0.21 cm²，偏差0.04 cm²）。
本研究建立并证实了一种基于诺模图的可靠且易于使用的方法，可准确量化重度AS。
