Cardiology Department, Kaiser Permanente Medical Center, Redwood City, California; Cardiology Department, California Pacific Medical Center, San Francisco, California.
Clin Cardiol. 2014 Mar;37(3):167-71. doi: 10.1002/clc.22236. Epub 2014 Jan 7.
The absence of auscultatory aortic valve closure sound is associated with severe aortic stenosis. The absence of Doppler-derived aortic opening (Aop ) or closing (Acl ) may be a sign of advanced severe aortic stenosis.
Absent Doppler-detected Aop or Acl transient is indicative of very severe aortic stenosis and is associated with adverse outcome.
A total of 118 consecutive patients with moderate (n = 63) or severe aortic stenosis (n = 55) were included. Aop and Acl signals were identified in a blinded fashion by continuous-wave Doppler. Patients with and without Aop and Acl were compared using χ(2) test for dichotomous variables and analysis of variance for continuous variables. The associations of Aop and Acl with aortic valve replacement were determined.
Aop or Acl were absent in 22 of 118 patients. The absence of Aop or Acl was associated with echocardiographic parameters of severe aortic stenosis. The absence of Aop or Acl was associated with incident aortic valve replacement (36.4% vs 7.3%, respectively, P < 0.001). Even in patients with aortic valve area <1 cm(2) , the absence of Aop or Acl was still associated with increased rate of aortic valve replacement (42.1% vs 13.9%, respectively, P = 0.019) and provided incremental predictive value over peak velocity.
In a typical population of patients with aortic stenosis, approximately 1 in 6 has no detectible aortic valve opening or closing Doppler signal. The absence of an Aop or Acl signal is a highly specific sign of severe aortic stenosis and is associated with incident aortic valve replacement.
听诊主动脉瓣关闭音缺失与严重主动脉瓣狭窄有关。多普勒检测到的主动脉瓣开放（Aop）或关闭（Acl）缺失可能是严重主动脉瓣狭窄的晚期征象。
多普勒检测到的 Aop 或 Acl 缺失提示严重主动脉瓣狭窄且与不良结局相关。
共纳入 118 例连续的中重度（n=63）或重度主动脉瓣狭窄（n=55）患者。连续波多普勒盲法识别 Aop 和 Acl 信号。使用卡方检验比较 Aop 和 Acl 存在和缺失患者的二分类变量，使用方差分析比较 Aop 和 Acl 存在和缺失患者的连续变量。评估 Aop 和 Acl 与主动脉瓣置换的关系。
118 例患者中有 22 例存在 Aop 或 Acl 缺失。Aop 或 Acl 缺失与严重主动脉瓣狭窄的超声心动图参数相关。Aop 或 Acl 缺失与主动脉瓣置换事件相关（分别为 36.4%和 7.3%，P<0.001）。即使在主动脉瓣面积<1cm2的患者中，Aop 或 Acl 缺失仍然与主动脉瓣置换率增加相关（分别为 42.1%和 13.9%，P=0.019），且比峰值流速具有更高的预测价值。
在典型的主动脉瓣狭窄患者人群中，大约 1/6 的患者不存在可检测到的主动脉瓣开放或关闭多普勒信号。Aop 或 Acl 信号缺失是严重主动脉瓣狭窄的高度特异性征象，与主动脉瓣置换事件相关。
