Second University of Naples, Monaldi Hospital, Naples, Italy.
Am J Cardiol. 2012 Oct 1;110(7):1051-5. doi: 10.1016/j.amjcard.2012.05.039. Epub 2012 Jun 22.
Aortic regurgitation (AR) has increased in the pediatric population because of the expanded use of new surgical and hemodynamic procedures. Unfortunately, the exact timing for operation in patients with AR is still debated. Conventional echocardiographic parameters, left ventricular (LV) dimensions and the LV ejection fraction, have limitations in predicting early LV dysfunction. Two-dimensional strain imaging, an emerging ultrasound technology, has the potential to better study those patients. The aim of this study was to assess the prognostic value of 2-dimensional longitudinal strain in young patients with congenital isolated moderate to severe AR. Twenty-six young patients with asymptomatic AR (aged 3 to 16 years) were studied. The mean follow-up duration was 2.9 ± 1.2 years (range 0.5 to 6). Baseline LV function by speckle-tracking and conventional echocardiography in patients with stable disease was compared with that in patients with progressive AR (defined as development of symptoms, increase in LV volume ≥15%, or decrease in the LV ejection fraction ≤10% during follow-up). LV ejection fractions were similar between groups. The jet area/LV outflow tract area ratio was significantly increased in patients with AR with progressive disease (31.2 ± 5.6% vs 39.2 ± 3.8%, p <0.001). The peak transmitral early velocity/early diastolic mitral annular velocity ratio was significantly increased in patients with progressive AR (p = 0.001). LV average longitudinal strain was significantly reduced in patients with progressive AR compared to those with stable AR (-17.8 ± 3.9% vs -22.7 ± 2.7%, p = 0.001). On multivariate analysis, the only significant risk factor for progressive AR was average LV longitudinal strain (p = 0.04, cut-off value >-19.5%, sensitivity 77.8%, specificity 94.1%, area under the curve 0.889). In conclusion, 2-dimensional strain imaging can discriminate young asymptomatic patients with progressive AR. This could allow young patients with AR to have a better definition of surgical timing before the occurrence of irreversible myocardial damage.
主动脉瓣反流（AR）在儿科人群中增加，因为新的手术和血液动力学方法的广泛应用。不幸的是，AR 患者的手术时机仍存在争议。传统的超声心动图参数，如左心室（LV）尺寸和 LV 射血分数，在预测早期 LV 功能障碍方面存在局限性。二维应变成像，一种新兴的超声技术，具有更好地研究这些患者的潜力。本研究旨在评估二维纵向应变在患有先天性孤立性中度至重度 AR 的年轻患者中的预后价值。研究了 26 名无症状 AR 年轻患者（年龄 3 至 16 岁）。平均随访时间为 2.9 ± 1.2 年（范围 0.5 至 6）。在稳定疾病的患者中，通过斑点追踪和传统超声心动图比较了基线 LV 功能与进行性 AR 患者（定义为随访期间出现症状、LV 容积增加≥15%或 LV 射血分数降低≤10%）。两组的 LV 射血分数相似。进展性 AR 患者的射流面积/LV 流出道面积比明显增加（31.2 ± 5.6% vs 39.2 ± 3.8%，p <0.001）。进展性 AR 患者的跨二尖瓣早期速度/早期舒张二尖瓣环速度比明显增加（p = 0.001）。与稳定 AR 患者相比，进展性 AR 患者的 LV 平均纵向应变明显降低（-17.8 ± 3.9% vs -22.7 ± 2.7%，p = 0.001）。多变量分析显示，进展性 AR 的唯一显著危险因素是 LV 平均纵向应变（p = 0.04，截断值>-19.5%，敏感性 77.8%，特异性 94.1%，曲线下面积 0.889）。总之，二维应变成像可区分进展性 AR 的无症状年轻患者。这可以使 AR 年轻患者在发生不可逆心肌损伤之前更好地确定手术时机。
