Bhattacharyya Sanjeev, Mittal Tarun, Abayalingam Mayavan, Kabir Tito, Dalby Miles, Cleland John G, Baltabaeva Aigul, Rahman Haley Shelley
Department of Cardiology, Harefield Hospital, London, United Kingdom Echocardiography Laboratory, Harefield Hospital, London, United Kingdom
Department of Imaging, Harefield Hospital, London, United Kingdom.
Angiology. 2016 Aug;67(7):664-9. doi: 10.1177/0003319715611804. Epub 2015 Oct 15.
Different patterns of flow and valve gradients can lead to diagnostic uncertainty about the severity of aortic stenosis (AS). Consecutive patients with severe AS (valve area <1 cm(2)) underwent echocardiography and computed tomography. Patients were classified into 4 groups (high-gradient/normal flow [HGNF], high-gradient/low flow [HGLF], low-gradient/normal flow [LGNF], and low-gradient/low flow [LGLF]). Low flow was defined as stroke volume index <35 mL/m(2) and low gradient as a mean aortic gradient <40 mm Hg. Aortic valve calcification (AVC) was calculated using the Agatston score. Of 181 patients, 56, 30, 46, and 49 had HGNF, HGLF, LGNF and LGLF with median AVC of 2048, 2015, 1366, and 1178 AU/m(2) (P < .0001) and valvuloarterial impedance of 4.5, 6.4, 4.2, and 5.9, respectively (P < .0001). Among those with LGLF, AVC was lower in patients with preserved compared to reduced left ventricular ejection fraction (1018 vs 2550 AU/m(2); P < .0001), but valvuloarterial impedance was similar (P = .33). The LGLF AS with preserved ejection fraction is associated with lower AVC and may identify patients with less severe AS in association with an adaptive ventricular response to high afterload.
不同的血流模式和瓣膜压差会导致对主动脉瓣狭窄（AS）严重程度的诊断存在不确定性。对连续的重度AS患者（瓣膜面积<1 cm²）进行了超声心动图和计算机断层扫描检查。患者被分为4组（高梯度/正常血流[HGNF]、高梯度/低血流[HGLF]、低梯度/正常血流[LGNF]和低梯度/低血流[LGLF]）。低血流定义为每搏量指数<35 mL/m²，低梯度定义为平均主动脉压差<40 mmHg。使用阿加斯顿评分计算主动脉瓣钙化（AVC）。在181例患者中，56例、30例、46例和49例分别为HGNF、HGLF、LGNF和LGLF，中位AVC分别为2048、2015、1366和1178 AU/m²（P<.0001），瓣膜动脉阻抗分别为4.5、6.4、4.2和5.9（P<.0001）。在LGLF患者中，与左心室射血分数降低的患者相比，左心室射血分数保留的患者AVC较低（1018 vs 2550 AU/m²；P<.0001），但瓣膜动脉阻抗相似（P = 0.33）。射血分数保留的LGLF AS与较低的AVC相关，可能识别出AS较轻且心室对高后负荷有适应性反应的患者。
