Christensen Nicolaj Lyhne, Dahl Jordi Sanchez, Carter-Storch Rasmus, Bakkestrøm Rine, Jensen Kurt, Steffensen Flemming Hald, Søndergaard Eva Vad, Videbæk Lars, Møller Jacob Eifer
From the Department of Cardiology, Odense University Hospital, Denmark (N.L.C., J.S.D., R.C.-S., R.B., E.V.S., L.V., J.E.M.); Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense (K.J.), and Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark (F.H.S.).
Circ Cardiovasc Imaging. 2016 Oct;9(10). doi: 10.1161/CIRCIMAGING.116.005156.
Transition from an asymptomatic to symptomatic state in severe aortic stenosis is often difficult to assess. Identification of a morphological sign of increased hemodynamic load may be important in asymptomatic aortic stenosis to identify patients at risk.
Thirty-nine patients with asymptomatic severe aortic stenosis (aortic valve area <1 cm, peak jet velocity >3.5 m/s) underwent exercise testing with simultaneous invasive hemodynamic monitoring and Doppler echocardiography. Cardiac index, pulmonary artery pressure, and pulmonary capillary wedge pressure (PCWP) were recorded. Patients were followed up for the composite end point of death, unplanned hospitalization, or aortic valve replacement. Patients were stratified into 2 groups according to left atrial (LA) volume index ≥35 mL/m. In 25 patients (64%) LA volume index was ≥35 mL/m. Aortic valve area was similar between groups (0.81±0.15 versus 0.84±0.18 cm; P=0.58). PCWP was higher at rest and during exercise in patients with LA volume index ≥35 mL/m (P<0.01), despite similar cardiac index. At rest, PCWP was <12 mm Hg in 11 patients (44%) with LA dilatation, whereas PCWP was <25 mm Hg in 1 patient (4%) with exercise. LA volume index and E/e' predicted exercise PCWP>30 mm Hg with areas under the receiver operating curve of 0.75 and 0.84, respectively. During follow-up, 14 cardiac events were recorded. LA volume was associated with a hazard ratio of 1.90 (95% confidence interval, 0.92-4.15).
LA size reflects hemodynamic burden in patients with asymptomatic severe aortic stenosis. Quantitative measurements of LA and diastolic function are associated with left ventricular filling pressures with exercise and could be used to identify asymptomatic patients with increased hemodynamic burden.
URL: http://www.clinicaltrials.gov. Unique identifier: NCT02395107.
重度主动脉瓣狭窄患者从无症状状态转变为有症状状态通常难以评估。识别血流动力学负荷增加的形态学征象对于无症状主动脉瓣狭窄患者识别风险患者可能很重要。
39例无症状重度主动脉瓣狭窄患者（主动脉瓣面积<1cm²，峰值射流速度>3.5m/s）接受了运动试验，同时进行有创血流动力学监测和多普勒超声心动图检查。记录心脏指数、肺动脉压和肺毛细血管楔压（PCWP）。对患者进行随访，观察死亡、非计划住院或主动脉瓣置换的复合终点。根据左心房（LA）容积指数≥35mL/m²将患者分为两组。25例患者（64%）的LA容积指数≥35mL/m²。两组间主动脉瓣面积相似（0.81±0.15对0.84±0.18cm²；P=0.58）。尽管心脏指数相似，但LA容积指数≥35mL/m²的患者在静息和运动时PCWP更高（P<0.01）。静息时，11例（44%）LA扩大患者的PCWP<12mmHg，而运动时1例（4%）患者的PCWP<25mmHg。LA容积指数和E/e'预测运动时PCWP>30mmHg，受试者工作特征曲线下面积分别为0.75和0.84。随访期间，记录了14例心脏事件。LA容积与风险比为1.90相关（95%置信区间，0.92-4.15）。
LA大小反映无症状重度主动脉瓣狭窄患者的血流动力学负担。LA和舒张功能的定量测量与运动时左心室充盈压相关，可用于识别血流动力学负担增加的无症状患者。
