Mizia-Stec Katarzyna, Mizia Magdalena, Sikora-Puz Agnieszka, Gieszczyk-Strózik Klaudia, Bochenek Tomasz, Lasota Bartosz, Chmiel Artur, Chudek Jerzy, Deja Marek, Płońska-Gościniak Edyta
1st Department of Cardiology, Medical University of Silesia, Katowice, Poland.
Kardiol Pol. 2016;74(6):537-46. doi: 10.5603/KP.a2015.0219. Epub 2015 Nov 17.
Prosthesis-patient mismatch (PPM) is an independent predictor of post-operative mortality after aortic valve replacement (AVR), particularly when it is associated with a left ventricle (LV) dysfunction. Two-dimensional speckle-tracking echocardiography (2D-STE) could be useful in assessing LV function in patients with PPM.
To evaluate the impact of PPM on myocardial multidirectional LV systolic strain in patients who are undergoing AVR for severe degenerative aortic stenosis (AS).
Sixty-five patients (38 females, 27 males, age: 69.9 ± 9.1 years) with severe degenerative AS and preserved LV ejection fraction were enrolled into the study. Pre- and three-month postoperative 2D-STE was performed to assess LV peak systolic longitudinal strain (LV PSLS), circumferential strain, and LV rotation. The indexed prosthesis effective orifice area (iEOAprosth) was used to define PPM (≤ 0.65 cm2/m2), and it was used to distinguish the study groups: PPM (+) (n = 35) and PPM (-) (n = 30).
A significant association of LV PSLS and interaction in the groups [PPM (+) vs. PPM (-)] and intervention (before vs. after AVR; p = 0.019) was observed - the lowest value of LV PSLS was in the PPM (+) group (-14.9 ± 3.5%) after AVR. A significant difference in the mean delta (before/after AVR) values of LV PSLS (0.7 ± 3.1% vs. -1.2 ± 3.6%; p = 0.04) in the PPM (+) vs. the PPM (-) groups was found. LV PSLS correlated with iEOAprosth (r = -0.520, p < 0.001) that was obtained three months after AVR.
The occurrence of PPM in patients undergoing AVR for severe degenerative AS was associated with reduced LV PSLS in a three-month observation.
人工瓣膜-患者不匹配（PPM）是主动脉瓣置换术（AVR）术后死亡率的独立预测因素，尤其是当它与左心室（LV）功能障碍相关时。二维斑点追踪超声心动图（2D-STE）可能有助于评估PPM患者的左心室功能。
评估PPM对因严重退行性主动脉瓣狭窄（AS）接受AVR治疗的患者心肌多方向左心室收缩期应变的影响。
65例严重退行性AS且左心室射血分数保留的患者（38例女性，27例男性，年龄：69.9±9.1岁）纳入研究。术前及术后三个月进行2D-STE以评估左心室峰值收缩期纵向应变（LV PSLS）、圆周应变和左心室旋转。采用指数化人工瓣膜有效开口面积（iEOAprosth）定义PPM（≤0.65 cm2/m2），并据此区分研究组：PPM（+）组（n = 35）和PPM（-）组（n = 30）。
观察到LV PSLS在组间[PPM（+）组与PPM（-）组]和干预（AVR术前与术后；p = 0.019）存在显著相关性及交互作用——AVR术后LV PSLS的最低值出现在PPM（+）组（-14.9±3.5%）。PPM（+）组与PPM（-）组LV PSLS的平均变化值（AVR术前/术后）存在显著差异（0.7±3.1%对-1.2±3.6%；p = 0.04）。LV PSLS与AVR术后三个月测得的iEOAprosth相关（r = -0.520，p < 0.001）。
在三个月的观察期内，因严重退行性AS接受AVR治疗的患者中PPM的发生与LV PSLS降低相关。
