术前射血分数决定慢性重度主动脉瓣反流患者主动脉瓣置换术后左心室舒张末期内径的早期恢复情况。
Preoperative ejection fraction determines early recovery of left ventricular end-diastolic dimension after aortic valve replacement for chronic severe aortic regurgitation.
作者信息
Zhang Zhiwei, Yang Junjie, Yu Yunsheng, Huang Haoyue, Ye Wenxue, Yan Weiya, Shen Han, Ii Masaaki, Shen Zhenya
机构信息
Department of Cardiovascular Surgery & Institute of Cardiovascular Science, The First Affiliated Hospital of Soochow University, Suzhou, China.
Institute for Cardiovascular Science of Soochow University, Suzhou, China.
出版信息
J Surg Res. 2015 Jun 1;196(1):49-55. doi: 10.1016/j.jss.2015.02.069. Epub 2015 Mar 6.
BACKGROUND
In patients with chronic severe aortic regurgitation (AR), aortic valve replacement (AVR) has been proved to promote left ventricular (LV) remodeling, especially LV end-diastolic dimension (LVEDD) reduction. However, there is little research whether postoperative LVEDD could return to normal parameter after AVR. The objective of this study was to determine predictors for the recovery of dilated LVEDD early after AVR.
METHODS
The echocardiographic data of 105 patients, who underwent AVR for chronic pure AR between January 2005 and December 2011, were analyzed at the preoperative (3-7 d), early (6-8 mo), and late (2-y) postoperative stages, retrospectively. According to the baseline level, LVEDD >70 mm or LV end-systolic dimension (LVESD) >50 mm or LVESD index >25 mm/m(2) were defined as severe LV dilation. Patients were then categorized into two groups (group 1: severe LV dilation; group 2: nonsevere LV dilation).
RESULTS
In all patients, four-fifth of the reduction in LV dimension occurred at early (6-8 mo) postoperative stage. The patients in both groups had significant decreases in the LVEDD and LVESD early after AVR, with an additional but insignificant reduction at late postoperative stage. The ejection fraction (EF) in both groups significantly increased at either early or late stage. However, the LVEDD and LVESD in group 1 were larger than those in group 2, and the EF in group 1 was lower than that in group 2 at early postoperative stage. By multivariate analysis, we found that the preoperative EF was a good predictor for the recovery of dilated LVEDD early after AVR (P = 0.009). Receiver-operating characteristics analysis showed that EF >52% was the best cut-off value for the recovery of LVEDD.
CONCLUSIONS
In patients with chronic pure AR, preoperative EF may be a good predictor for successful recovery of dilated LVEDD early after AVR.
背景
在慢性重度主动脉瓣反流（AR）患者中，主动脉瓣置换术（AVR）已被证明可促进左心室（LV）重构，尤其是左心室舒张末期内径（LVEDD）减小。然而，关于AVR术后LVEDD能否恢复至正常参数的研究较少。本研究的目的是确定AVR术后早期扩张的LVEDD恢复的预测因素。
方法
回顾性分析2005年1月至2011年12月期间因慢性单纯AR接受AVR的105例患者的超声心动图数据，分别于术前（3 - 7天）、术后早期（6 - 8个月）和晚期（2年）进行分析。根据基线水平，LVEDD>70 mm或左心室收缩末期内径（LVESD）>50 mm或LVESD指数>25 mm/m²被定义为严重左心室扩张。然后将患者分为两组（第1组：严重左心室扩张；第2组：非严重左心室扩张）。
结果
在所有患者中，五分之四的左心室尺寸减小发生在术后早期（6 - 8个月）。两组患者在AVR术后早期LVEDD和LVESD均显著降低，术后晚期虽有额外降低但不显著。两组患者在早期或晚期射血分数（EF）均显著增加。然而，术后早期第1组的LVEDD和LVESD大于第2组，第1组的EF低于第2组。通过多因素分析，我们发现术前EF是AVR术后早期扩张的LVEDD恢复的良好预测因素（P = 0.009）。受试者工作特征分析表明，EF>52%是LVEDD恢复的最佳截断值。
结论
在慢性单纯AR患者中，术前EF可能是AVR术后早期扩张的LVEDD成功恢复的良好预测因素。
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