Dalsgaard Morten, Kjaergaard Jesper, Pecini Redi, Iversen Kasper Karmark, Kober Lars, Moller Jacob Eifer, Grande Peer, Clemmensen Peter, Hassager Christian
Department of Cardiology B2142, Rigshospitalet, Copenhagen University Hospital, DK-2100 Copenhagen Ø, Denmark.
Eur J Echocardiogr. 2010 Jul;11(6):482-7. doi: 10.1093/ejechocard/jeq002. Epub 2010 Feb 6.
This study investigated the association between invasive and non-invasive estimates of left ventricular (LV) filling pressure and exercise capacity, in order to find new potential candidates for risk markers in severe aortic valve stenosis (AS).
Twenty-nine patients with AS, aortic valve area (AVA) < 1 cm(2), performed a symptom-limited multistage supine bicycle exercise test. Immediately before the exercise test, the pulmonary capillary wedge pressure (PCWP), Doppler index for LV filling (E/e'), and left atrial (LA) volume were measured. Symptomatic status was determined by senior staff doctors blinded to the results of this study. All patients terminated the exercise test because of dyspnoea. There were no significant differences in AVA between asymptomatic patients (n = 9) and symptomatic patients (n = 20), and AVA did not correlate with exercise capacity (r = -0.16, P = NS). In contrast, PCWP, LA volume, and E/e' were significantly increased in the symptomatic group and they all correlated with exercise capacity (r = -0.66, -0.75, and -0.62, respectively, P < 0.001). Receiver operating characteristic curve analysis confirmed that PCWP, LA volume index, and E/e' all provided incremental information [area under the curve (AUC) = 0.90, 0.92, and 0.90, respectively, P < 0.05] over AVA index (AUC = 0.66, NS) in predicting symptomatic status.
PCWP, LA volume, or E/e' is closely related to exercise capacity and symptomatic status, and may therefore be important markers of disease severity in AS. Clinical Trials.gov Identifier: NCT00252317 (http://clinicaltrials.gov/ct2/results?term=NCT00252317).
本研究调查左心室（LV）充盈压的有创和无创评估与运动能力之间的关联，以便在严重主动脉瓣狭窄（AS）中找到新的潜在风险标志物候选指标。
29例主动脉瓣面积（AVA）<1 cm²的AS患者进行了症状限制的多级仰卧位自行车运动试验。在运动试验前即刻，测量肺毛细血管楔压（PCWP）、左心室充盈多普勒指数（E/e'）和左心房（LA）容积。症状状态由对本研究结果不知情的高级 staff 医生确定。所有患者均因呼吸困难终止运动试验。无症状患者（n = 9）和有症状患者（n = 20）之间的AVA无显著差异，且AVA与运动能力无相关性（r = -0.16，P = 无显著性差异）。相比之下，有症状组的PCWP、LA容积和E/e'显著升高，且它们均与运动能力相关（分别为r = -0.66、-0.75和-0.62，P < 0.001）。受试者工作特征曲线分析证实，在预测症状状态方面，PCWP、LA容积指数和E/e'均比AVA指数[曲线下面积（AUC）= 0.66，无显著性差异]提供了更多信息（AUC分别为0.90、0.92和0.90，P < 0.05）。
PCWP、LA容积或E/e'与运动能力和症状状态密切相关，因此可能是AS疾病严重程度的重要标志物。临床试验.gov标识符：NCT00252317（http://clinicaltrials.gov/ct2/results?term=NCT00252317）。
