Roman M J, Devereux R B, Kramer-Fox R, O'Loughlin J
Department of Medicine, New York Hospital-Cornell Medical Center, New York 10021.
Am J Cardiol. 1989 Sep 1;64(8):507-12. doi: 10.1016/0002-9149(89)90430-x.
Two-dimensional echocardiography is increasingly used to measure aortic root dimensions, which provide prognostic information in aortic regurgitation and the Marfan syndrome. Aortic root dilatation is currently detected by nomograms based on M-mode echocardiographic data. Aortic root diameters measured by 2-dimensional echocardiography at the anulus, sinuses of Valsalva, supra-aortic ridge and proximal ascending aorta in 135 normal adults and 52 normal children were compared with age, gender, body habitus, blood pressure and stroke volume, and with M-mode findings and normal limits. Two-dimensional measurements at the sinuses of Valsalva were larger than M-mode aortic root values (p less than 0.001), and use of 2-dimensional values with M-mode nomograms falsely diagnosed aortic dilatation in 40% of normal children and 19% of normal adults. Two-dimensional measurements at the sinuses closely correlated with body surface area in children (r = 0.93, p less than 0.0005), moderately in adults younger than 40 years of age (r = 0.71, p less than 0.0005) and weakly in older adults (r = 0.40, p less than 0.0005). In adults, gender influenced aortic root size at all levels (p less than 0.001), but dimensions were similar when indexed for body surface area. Age strongly influenced supraaortic ridge and ascending aortic diameters; blood pressure and stroke volume had no independent effect on aortic size. In conclusion, (1) 2-dimensional echocardiographic aortic root dimensions are influenced by age and body size but not by blood pressure; (2) aortic root dilatation is overdiagnosed when aortic diameter at the sinuses of Valsalva is compared with M-mode nomograms; (3) nomograms comparing aortic diameter with body surface area should be used in children; and (4) although use of nomograms based on body size in adults should maximize sensitivity for aortic dilatation, 98% specificity is attained by use of an upper normal limit of 2.1 cm/m2 for aortic diameter at the sinuses of Valsalva in both men and women.
二维超声心动图越来越多地用于测量主动脉根部尺寸，这可为主动脉反流和马方综合征提供预后信息。目前，主动脉根部扩张是通过基于M型超声心动图数据的列线图来检测的。对135名正常成年人和52名正常儿童在瓣环、主动脉窦、主动脉上嵴和升主动脉近端处用二维超声心动图测量的主动脉根部直径，与年龄、性别、体型、血压和心搏量进行比较，并与M型超声心动图结果及正常范围进行比较。在主动脉窦处的二维测量值大于M型超声心动图测量的主动脉根部值（p<0.001），在40%的正常儿童和19%的正常成年人中，使用二维测量值结合M型超声心动图列线图会错误诊断为主动脉扩张。在儿童中，主动脉窦处的二维测量值与体表面积密切相关（r=0.93，p<0.0005），在40岁以下成年人中相关性中等（r=0.71，p<0.0005），在老年人中相关性较弱（r=0.40，p<0.0005）。在成年人中，性别在各个水平均影响主动脉根部大小（p<0.001），但以体表面积指数化后尺寸相似。年龄强烈影响主动脉上嵴和升主动脉直径；血压和心搏量对主动脉大小无独立影响。总之，（1）二维超声心动图测量的主动脉根部尺寸受年龄和体型影响，但不受血压影响；（2）将主动脉窦处的主动脉直径与M型超声心动图列线图比较时，主动脉根部扩张会被过度诊断；（3）儿童应使用将主动脉直径与体表面积进行比较的列线图；（4）尽管在成年人中使用基于体型的列线图应能最大程度提高对主动脉扩张的敏感性，但通过将主动脉窦处主动脉直径的正常上限设定为2.1cm/m²，男性和女性的特异性均可达到98%。
