Shub C, Tajik A J, Holmes D R, Reeder G S, Freeman W K, Ilstrup D M, Smith H C
Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905.
Int J Cardiol. 1990 Jul;28(1):57-66. doi: 10.1016/0167-5273(90)90009-t.
The clinical utility of Doppler echocardiography for the assessment of aortic stenosis was prospectively studied in 425 consecutive patients referred to the echocardiography laboratory over 1 year with the clinical diagnosis of aortic stenosis. Optimal peak Doppler velocities were obtained in 405 (95%) patients of all ages. In 108 patients, the severity of aortic stenosis as determined by subsequent cardiac catheterization was compared with that found by Doppler assessment. Categorization of severity was concordant in 8 (89%) of 9 cases of mild aortic stenosis and in 28 (78%) of 36 cases of severe aortic stenosis, but there was considerable diagnostic overlap in cases of moderate stenosis. Forty-nine patients with mild aortic stenosis as determined clinically had moderate or severe stenosis as assessed by Doppler; 7 (14%) of these patients underwent subsequent replacement of the aortic valve. Increased aortic velocity, as determined by Doppler, was associated with a significant incidence of subsequent (mean follow-up period, 22 months) cardiac events (cardiac death, aortic valvar replacement, New York Heart Association functional class III or IV). Patients with mild aortic stenosis as assessed by Doppler (peak aortic velocity less than 2.5 m/sec) had greater than 95% event-free survival at 1 year and rarely required cardiac catheterization. Conversely, only 45% of patients with severe aortic stenosis as determined by Doppler were free of a cardiovascular event at 1 year. Although the noninvasive assessment of aortic stenosis should ideally include determination of the area of the aortic valve and the mean aortic gradient by Doppler echocardiography, this is not always possible. Prognostic information derived from peak aortic velocity alone is clinically useful. It has the additional advantage that it is much less laborious and time-consuming to obtain and is obtainable in almost all (99%) patients.
对425例连续1年被转诊至超声心动图实验室、临床诊断为主动脉瓣狭窄的患者，前瞻性研究了多普勒超声心动图评估主动脉瓣狭窄的临床效用。所有年龄段的405例（95%）患者获得了最佳峰值多普勒速度。在108例患者中，将后续心脏导管检查确定的主动脉瓣狭窄严重程度与多普勒评估结果进行了比较。轻度主动脉瓣狭窄的9例中有8例（89%）、重度主动脉瓣狭窄的36例中有28例（78%）严重程度分类一致，但中度狭窄病例存在相当大的诊断重叠。临床诊断为轻度主动脉瓣狭窄的49例患者经多普勒评估为中度或重度狭窄；其中7例（14%）患者随后接受了主动脉瓣置换。多普勒测定的主动脉速度增加与后续（平均随访期22个月）心脏事件（心源性死亡、主动脉瓣置换、纽约心脏协会功能分级III或IV级）的显著发生率相关。经多普勒评估为轻度主动脉瓣狭窄（主动脉峰值速度小于2.5米/秒）的患者1年无事件生存率大于95%，很少需要心脏导管检查。相反，经多普勒确定为重度主动脉瓣狭窄的患者1年时只有45%无心血管事件。虽然主动脉瓣狭窄的无创评估理想情况下应包括通过多普勒超声心动图测定主动脉瓣面积和平均主动脉压力阶差，但这并非总是可行的。仅从主动脉峰值速度得出的预后信息在临床上是有用的。它还有一个额外的优点，即获取时费力少、耗时短，并且几乎在所有（99%）患者中都可获得。
