Ben-Dor Itsik, Goldstein Steven A, Waksman Ron, Satler Lowell F, Li Yanlin, Syed Asmir I, Maluenda Gabriel, Collins Sara D, Suddath William O, Torguson Rebecca, Xue Zhenyi, Kaneshige Kimberly, Okubagzi Petros, Wang Zuyue, Kent Kenneth M, Pichard Augusto D
Division of Cardiology, Washington Hospital Center, Washington, DC, USA.
Am J Cardiol. 2009 Sep 15;104(6):850-5. doi: 10.1016/j.amjcard.2009.05.012. Epub 2009 Jul 18.
The aim of this study was to assess the change in coronary flow in patients who underwent percutaneous aortic valve replacement (PAVR) for severe aortic stenosis. The left main coronary artery was visualized using transesophageal echocardiography in 17 patients who underwent PAVR. The peak systolic and diastolic velocities of coronary flow and the time-velocity integral were obtained before and after PAVR using pulsed-wave Doppler. The median age was 80.0 years (interquartile range [IQR] 80.0 to 88.0). Median gradients decreased from 40.0 mm Hg (IQR 35.0 to 50.0) before PAVR to 4.0 mm Hg (IQR 2.75 to 4.2) afterward (p <0.001). Aortic valve area increased from 0.6 cm(2) (IQR 0.5 to 0.7) to 1.9 cm(2) (IQR 1.7 to 2.0) (p <0.001). Cardiac output increased from 3.3 L/min (IQR 2.4 to 4.0) to 3.6 L/min (IQR 3.1 to 4.4) (p <0.001). Aortic systolic pressure did not change significantly, from 126.0 mm Hg (IQR 11.7 to 137.7) before to 134 mm Hg (IQR 116.3 to 142.5) after valve implantation (p = 0.8). Left ventricular end-diastolic pressure decreased significantly from 19.0 mm Hg (IQR 18.0 to 22.0) before to 14.0 mm Hg (IQR 12.0 to 17.0) after valve implantation (p = 0.01). The medians of the following coronary flow parameters increased significantly after PAVR: peak systolic velocity, 25.0 cm/s (IQR 17.0 to 30.0) to 37.0 cm/s (IQR 23.0 to 44.0) (p <0.001); peak diastolic velocity, 49.0 cm/s (IQR 39.5 to 61.0) to 57.0 cm/s (IQR 42.9 to 83.9) (p = 0.006); total velocity-time integral, 23.7 cm (IQR 15.0 to 27.1) to 28.1 cm (IQR 21.3 to 34.7) (p = 0.001); and systolic velocity-time integral, 5.4 cm (IQR 3.5 to 6.2) to 9.0 cm (IQR 4.5 to 9.8) (p = 0.001). The diastolic time-velocity integral increased from 17.2 cm (IQR 12.0 to 24.0) to 20.1 cm (IQR 15.0 to 25.9) (p = 0.02). In conclusion, after PAVR, there is a significant increase in coronary flow as measured by peak systolic velocity, diastolic velocity, and velocity-time integral using pulsed-wave Doppler by transesophageal echocardiography.
本研究的目的是评估接受经皮主动脉瓣置换术（PAVR）治疗严重主动脉瓣狭窄患者的冠状动脉血流变化。在17例接受PAVR的患者中，使用经食管超声心动图观察左主干冠状动脉。使用脉冲波多普勒在PAVR前后获取冠状动脉血流的收缩期峰值速度、舒张期速度和时间速度积分。中位年龄为80.0岁（四分位间距[IQR]80.0至88.0）。中位压差从PAVR前的40.0 mmHg（IQR 35.0至50.0）降至术后的4.0 mmHg（IQR 2.75至4.2）（p<0.001）。主动脉瓣面积从0.6 cm²（IQR 0.5至0.7）增加至1.9 cm²（IQR 1.7至2.0）（p<0.001）。心输出量从3.3 L/min（IQR 2.4至4.0）增加至3.6 L/min（IQR 3.1至4.4）（p<0.001）。主动脉收缩压无显著变化，从术前的126.0 mmHg（IQR 11.7至137.7）至瓣膜植入后的134 mmHg（IQR 116.3至142.5）（p = 0.8）。左心室舒张末期压力从术前的19.0 mmHg（IQR 18.0至22.0）显著降至瓣膜植入后的14.0 mmHg（IQR 12.0至17.0）（p = 0.01）。以下冠状动脉血流参数的中位数在PAVR后显著增加：收缩期峰值速度，从25.0 cm/s（IQR 17.0至30.0）增至37.0 cm/s（IQR 23.0至44.0）（p<0.001）；舒张期峰值速度，从49.0 cm/s（IQR 39.5至61.0）增至57.0 cm/s（IQR 42.9至83.9）（p = 0.006）；总速度时间积分，从23.7 cm（IQR 15.0至27.1）增至28.1 cm（IQR 21.3至34.7）（p = 0.001）；以及收缩期速度时间积分，从5.4 cm（IQR 3.5至6.2）增至9.0 cm（IQR 4.5至9.8）（p = 0.001）。舒张期时间速度积分从17.2 cm（IQR 12.0至24.0）增至20.1 cm（IQR 15.0至25.9）（p = 0.02）。总之，PAVR后，经食管超声心动图使用脉冲波多普勒测量的冠状动脉血流，其收缩期峰值速度、舒张期速度和速度时间积分显著增加。
