Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA.
Circ Cardiovasc Interv. 2012 Jun;5(3):406-14. doi: 10.1161/CIRCINTERVENTIONS.111.967836. Epub 2012 May 29.
Aortic valve area (AVA) in aortic stenosis (AS) can be assessed noninvasively or invasively, typically with similar results. These techniques have not been validated in elderly patients, where common assumptions make them most prone to error. Accurate assessment of AVA is crucial to determine which patients are appropriate candidates for aortic valve replacement.
Fifty elderly patients (mean 86 years, 46% female) referred for cardiac catheterization to evaluate AS also underwent transthoracic echocardiography within 24 hours. To minimize assumptions all patients had 3-dimensional echocardiography (Echo-3D), and at catheterization using directly measured oxygen consumption (Cath-mVo(2)) and thermodilution cardiac output (Cath-TD). Correlation between Cath-mVo(2) and Echo-3D AVA was poor (r=0.41). Cath-TD AVA had a moderate correlation with Echo-3D AVA (r=0.59). Cath-mVo(2) (AVA=0.69 cm(2)) and Cath-TD (AVA=0.66 cm(2)) underestimated AVA compared with Echo-3D (AVA=0.76 cm(2;) P=0.08 for comparison with Cath-mVo(2); P=0.001 for Cath-TD). Compared with Echo-3D, the sensitivity and specificity for determining critical disease (AVA <0.8 cm(2)) were 81% and 42% for Cath-mVo(2), and 97% and 53% for Cath-TD. The only independent predictor of the difference between noninvasive and invasive AVA was stroke volume index (P<0.01). Resistance, a less flow-dependent measure, showed a stronger correlation between Echo-3D and Cath-mVo(2) (r=0.69), and Echo-3D and Cath-TD (r=0.77).
Standard techniques of AVA assessment for AS show poor correlation in elderly patients, with frequent misclassification of critical AS. Less flow-dependent measures, such as resistance, should be considered to ensure that only appropriate patients are treated with aortic valve replacement.
在主动脉瓣狭窄（AS）中，主动脉瓣口面积（AVA）可以通过非侵入性或侵入性方法进行评估，通常结果相似。这些技术尚未在老年患者中得到验证，在老年患者中，常见的假设使它们最容易出错。准确评估 AVA 对于确定哪些患者是主动脉瓣置换的合适候选者至关重要。
50 名因疑似 AS 而接受心脏导管检查的老年患者（平均年龄 86 岁，46%为女性）在 24 小时内接受了经胸超声心动图检查。为了尽量减少假设，所有患者均进行了三维超声心动图（Echo-3D）检查，在导管检查时使用直接测量的耗氧量（Cath-mVo(2)）和温度稀释心输出量（Cath-TD）。Cath-mVo(2)与 Echo-3D AVA 的相关性较差（r=0.41）。Cath-TD AVA 与 Echo-3D AVA 的相关性中等（r=0.59）。与 Echo-3D 相比，Cath-mVo(2)（AVA=0.69 cm(2)）和 Cath-TD（AVA=0.66 cm(2)）低估了 AVA（比较 Cath-mVo(2)，P=0.08；比较 Cath-TD，P=0.001）。与 Echo-3D 相比，Cath-mVo(2) 确定临界疾病（AVA<0.8 cm(2)）的敏感性和特异性分别为 81%和 42%，Cath-TD 为 97%和 53%。非侵入性和侵入性 AVA 之间差异的唯一独立预测因子是每搏量指数（P<0.01）。阻力是一种较少依赖流量的测量方法，与 Echo-3D 和 Cath-mVo(2)（r=0.69）以及 Echo-3D 和 Cath-TD（r=0.77）之间的相关性更强。
AS 的标准 AVA 评估技术在老年患者中相关性较差，经常导致临界 AS 的错误分类。应考虑使用阻力等较少依赖流量的测量方法，以确保仅对合适的患者进行主动脉瓣置换治疗。
