Salinger Tim, Hu Kai, Liu Dan, Herrmann Sebastian, Lorenz Kristina, Ertl Georg, Nordbeck Peter
Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany.
Comprehensive Heart Failure Center (CHFC), University of Würzburg, Würzburg, Germany.
BMC Cardiovasc Disord. 2017 Mar 22;17(1):86. doi: 10.1186/s12872-017-0519-0.
Aortic valve stenosis is a common finding diagnosed with high sensitivity in transthoracic echocardiography, but the examiner often finds himself confronted with uncertain results in patients with moderate pressure gradients and concomitant systolic heart failure. While patients with true-severe low-gradient aortic valve stenosis with either reduced or preserved left ventricular systolic function are primarily candidates for valve replacement, there is a relevant proportion of patients with pseudo-severe aortic valve stenosis anticipated not to benefit but actually rather deteriorate by interventional therapy or surgery.
In this article we present a case report of a male patient with pseudo-severe aortic valve stenosis due to cardiac amyloidosis highlighting the diagnostic schedule. The patient underwent stress echocardiography because of discrepant findings in transthoracic echocardiography and cardiac catheterization regarding the severity of aortic valve stenosis. After evaluation of the results, it became clear that he had a need for optimum heart failure medication and implantation of a cardiac resynchronization therapy defibrillator.
Due to the pitfalls in conventional as well as invasive diagnostics at rest, Stress echocardiography should be considered part of the standard optimum diagnostic spectrum in all unclear or borderline cases in order to confirm the correct diagnosis and constitute optimal therapy.
主动脉瓣狭窄是经胸超声心动图检查中常见的发现，诊断敏感性较高，但检查者在面对中度压力阶差并伴有收缩性心力衰竭的患者时，常常会遇到结果不确定的情况。虽然真正严重的低压力阶差主动脉瓣狭窄且左心室收缩功能降低或保留的患者主要是瓣膜置换的候选人，但有相当一部分假性严重主动脉瓣狭窄患者预计无法从介入治疗或手术中获益，实际上病情反而会恶化。
在本文中，我们报告了一例因心脏淀粉样变性导致假性严重主动脉瓣狭窄的男性患者病例，重点介绍了诊断流程。该患者因经胸超声心动图和心导管检查在主动脉瓣狭窄严重程度方面的结果不一致而接受了负荷超声心动图检查。在评估结果后，明确他需要优化心力衰竭药物治疗并植入心脏再同步化治疗除颤器。
由于静息状态下传统及侵入性诊断存在的缺陷，在所有不明确或临界病例中，负荷超声心动图应被视为标准最佳诊断范围的一部分，以确认正确诊断并制定最佳治疗方案。
