Otto C M, Pearlman A S, Gardner C L
Division of Cardiology, University of Washington, Seattle 98195.
J Am Coll Cardiol. 1989 Mar 1;13(3):545-50. doi: 10.1016/0735-1097(89)90590-1.
Doppler echocardiography was used to follow the hemodynamic severity of aortic stenosis. First, the reproducibility of repeat recordings (mean interval 28 +/- 36 days) of aortic jet velocity, made by two independent observers, was tested in 38 adults with aortic stenosis and unchanged clinical status. The two recordings of maximal velocity correlated well (r = 0.96, y = 0.88x + 0.46m/s, SEE = 0.21 m/s) with a mean coefficient of variation of 3.2%. Repeat recording of left ventricular outflow tract velocity by two independent observers in 10 other patients with aortic stenosis also correlated well (r = 0.94, y = 1.06x + 0.0 m/s, SEE = 0.06 m/s) with a mean coefficient of variation of 4.6%. Next, Doppler echocardiography was used to study 42 patients with aortic stenosis (mean age 66 years) over a follow-up interval of 6 to 43 months (mean 20). Maximal aortic jet velocity increased by 0.36 m/s per year (range -0.3 to +1.0 m/s per year). Mean transaortic pressure gradient changed by -7 to +23 (mean 8) mm Hg/year. Aortic valve area by the continuity equation (n = 25) decreased by 0 to 0.5 cm2/year (mean decrease 0.1 cm2/year). Some patients had a worsening of stenosis (decrease in valve area) even though they had no change or a decrease in pressure gradient, because of concurrent decreases in transaortic volume flow. Twenty-one patients (50%) developed new or progressive symptoms of aortic stenosis necessitating valve replacement.(ABSTRACT TRUNCATED AT 250 WORDS)
采用多普勒超声心动图来跟踪主动脉瓣狭窄的血流动力学严重程度。首先，在38例临床状态未变的主动脉瓣狭窄成年患者中，测试了由两名独立观察者进行的主动脉血流速度重复记录（平均间隔28±36天）的可重复性。最大速度的两次记录相关性良好（r = 0.96，y = 0.88x + 0.46m/s，标准误 = 0.21 m/s），平均变异系数为3.2%。在另外10例主动脉瓣狭窄患者中，两名独立观察者对左心室流出道速度的重复记录也相关性良好（r = 0.94，y = 1.06x + 0.0 m/s，标准误 = 0.06 m/s），平均变异系数为4.6%。接下来，采用多普勒超声心动图对42例主动脉瓣狭窄患者（平均年龄66岁）进行了6至43个月（平均20个月）的随访研究。主动脉最大血流速度每年增加0.36 m/s（范围为每年 -0.3至 +1.0 m/s）。平均跨主动脉压力阶差每年变化 -7至 +23（平均8）mmHg。根据连续方程计算的主动脉瓣面积（n = 25）每年减少0至0.5 cm²（平均减少0.1 cm²）。一些患者尽管压力阶差没有变化或降低，但由于跨主动脉血流量同时减少，仍出现了狭窄加重（瓣膜面积减小）的情况。21例患者（50%）出现了新的或进行性的主动脉瓣狭窄症状，需要进行瓣膜置换。（摘要截选至250词）
