University Heart Center Freiburg/Bad Krozingen, Bad Krozingen, Germany.
Department of Cardiology, University Hospital Basel, Switzerland.
Heart. 2014 Jul;100(13):1024-30. doi: 10.1136/heartjnl-2013-305225. Epub 2014 Apr 29.
Adjustment of cardiac dimensions by measures of body size appears intuitively convincing and in patients with aortic stenosis, aortic valve area (AVA) is commonly adjusted by body surface area (BSA). However, there is little evidence to support such an approach.
To identify the adequate measure of body size for the adjustment of aortic stenosis severity.
Parameters of aortic stenosis severity (jet velocity, mean pressure gradient (MPG) and AVA) and measures of body size (height, weight, BSA and body mass index (BMI)) were analysed in 2843 consecutive patients with aortic stenosis (jet velocity ≥2.5 m/s) and related to outcomes in a second cohort of 1525 patients from the Simvastatin/Ezetimibe in Aortic Stenosis (SEAS) study.
Whereas jet velocity and MPG were independent of body size, AVA was significantly correlated with height, weight, BSA and BMI (Pearson correlation coefficient (r) 0.319, 0.281, 0.317 and 0.126, respectively, all p<0.001) to the effect that larger patients presented with larger AVA (less severe stenosis). Of the anthropometric measures used for linear adjustment, BSA was most effective in eliminating the correlation between AVA and body size (r=0.007), rivalled only by allometric (non-linear) models, findings that are confirmed in 1525 prospectively followed patients from the SEAS study. Predictive accuracy for aortic valve events and cardiovascular death during 46 months of follow-up was unchanged by adjusting AVA, regardless of measure of body size (area under the receiver operating curve for AVA 0.72 (CI 0.58 to 0.87) versus, for example, AVA/BSA 0.75 (CI 0.61 to 0.88), p=0.22).
In the assessment of aortic stenosis, linear adjustment of AVA by BSA improves comparability between patients with diverging body size without, however, increasing the predictive accuracy for clinical events in a population with mild to moderate stenosis.
通过身体尺寸的测量来调整心脏尺寸，这种方法直观上似乎令人信服，在主动脉瓣狭窄患者中，通常通过体表面积（BSA）来调整主动脉瓣口面积（AVA）。然而，目前几乎没有证据支持这种方法。
确定调整主动脉瓣狭窄严重程度的合适身体尺寸测量方法。
在 2843 例主动脉瓣狭窄（射流速度≥2.5m/s）连续患者中分析了主动脉瓣狭窄严重程度的参数（射流速度、平均压力梯度（MPG）和 AVA）和身体尺寸的测量方法（身高、体重、BSA 和体重指数（BMI）），并与来自 Simvastatin/Ezetimibe in Aortic Stenosis（SEAS）研究的 1525 例患者的第二队列中的结果相关联。
尽管射流速度和 MPG 与身体尺寸无关，但 AVA 与身高、体重、BSA 和 BMI 显著相关（Pearson 相关系数（r）分别为 0.319、0.281、0.317 和 0.126，均 p<0.001），这意味着较大的患者具有较大的 AVA（狭窄程度较轻）。在用于线性调整的人体测量学指标中，BSA 最有效地消除了 AVA 与身体尺寸之间的相关性（r=0.007），仅略逊于比例（非线性）模型，这一发现在来自 SEAS 研究的 1525 例前瞻性随访患者中得到了证实。在 46 个月的随访期间，调整 AVA 对主动脉瓣事件和心血管死亡的预测准确性没有改变，无论使用哪种身体尺寸测量方法（AVA 的接收者操作特征曲线下面积为 0.72（CI 0.58 至 0.87），例如 AVA/BSA 为 0.75（CI 0.61 至 0.88），p=0.22）。
在评估主动脉瓣狭窄时，通过 BSA 对 AVA 进行线性调整可改善具有不同身体尺寸的患者之间的可比性，而不会增加轻度至中度狭窄人群中临床事件的预测准确性。
