Koto Dan, Izumo Masaki, Machida Takafumi, Suzuki Kengo, Yoneyama Kihei, Suzuki Tomomi, Kamijima Ryo, Kobayashi Yasuyuki, Harada Tomoo, Akashi Yoshihiro J
Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, 216-8511, Japan.
Department of Pharmacology, St. Marianna University School of Medicine, Kawasaki, Japan.
J Echocardiogr. 2018 Dec;16(4):162-172. doi: 10.1007/s12574-018-0383-7. Epub 2018 May 24.
It is unclear how upper septal hypertrophy (USH) affects Doppler-derived left ventricular stroke volume (SV) in patients with AS. The aims of this study were to: (1) validate the accuracy of 3D transesophageal echocardiography (TEE) measurements of the left ventricular outflow tract (LVOT), (2) evaluate the differences in LVOT geometry between AS patients with and without USH, and (3) assess the impact of USH on measurement of SV.
In protocol 1, both 3D TEE and multi-detector computed tomography were performed in 20 patients with AS [aortic valve area (AVA) ≤ 1.5 cm]. Multiplanar reconstruction was used to measure the LVOT short and long diameters in four parts from the tip of the septum to the annulus. In protocol 2, the same 3D TEE measurements were performed in AS patients (AVA ≤ 1.5 cm, n = 129) and controls (n = 30). We also performed 2D and 3D transthoracic echocardiography in all patients.
In protocol 1, excellent correlations of LVOT parameters were found between the two modalities. In protocol 2, the USH group had smaller LVOT short and long diameters than the non-USH group. Although no differences in mean pressure gradient, or SV calculated with the 3D method existed between the two groups, the USH group had greater SV calculated with the Doppler method (73 ± 15 vs. 66 ± 15 ml) and aortic valve area (0.89 ± 0.26 vs. 0.73 ± 0.24 cm) than the non-USH group.
3D TEE can provide a precise assessment of the LVOT in AS. USH affects the LVOT geometry in patients with AS, which might lead to inaccurate assessments of disease severity.
目前尚不清楚上间隔肥厚（USH）如何影响主动脉瓣狭窄（AS）患者经多普勒测量的左心室每搏输出量（SV）。本研究的目的是：（1）验证经食管三维超声心动图（TEE）测量左心室流出道（LVOT）的准确性，（2）评估有USH和无USH的AS患者之间LVOT几何形态的差异，以及（3）评估USH对SV测量的影响。
在方案1中，对20例AS患者[主动脉瓣面积（AVA）≤1.5 cm²]同时进行了三维TEE和多排螺旋计算机断层扫描。采用多平面重建技术，从室间隔尖端到瓣环的四个部位测量LVOT的短径和长径。在方案2中，对AS患者（AVA≤1.5 cm²，n = 129）和对照组（n = 30）进行了相同的三维TEE测量。所有患者还进行了二维和三维经胸超声心动图检查。
在方案1中，两种检查方法测得的LVOT参数具有良好的相关性。在方案2中，USH组的LVOT短径和长径均小于非USH组。尽管两组之间平均压力阶差或三维方法计算的SV没有差异，但USH组用多普勒法计算的SV（73±15 vs. 66±15 ml）和主动脉瓣面积（0.89±0.26 vs. ？0.73±0.24 cm²）均大于非USH组。
三维TEE能够对AS患者的LVOT进行精确评估。USH影响AS患者的LVOT几何形态，这可能导致对疾病严重程度的评估不准确。 （注：原文中“0.73±?0.24 cm²”这里的问号可能是原文录入错误，翻译时保留原样）
