Liu Dan, Hu Kai, Liebner Eva, Weidemann Frank, Herrmann Sebastian, Ertl Georg, Frantz Stefan, Nordbeck Peter
Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany.
Comprehensive Heart Failure Center, Würzburg, Germany.
Int J Cardiovasc Imaging. 2018 Dec;34(12):1877-1887. doi: 10.1007/s10554-018-1416-z. Epub 2018 Jul 23.
Low-dose dobutamine stress echocardiography (DSE) is a valuable tool to distinguish true-severe (TS) from pseudo-severe (PS) low gradient aortic valve stenosis (LGAS) in patients with reduced left ventricular ejection fraction (LVEF). However, only scanty studies reported the clinical utility of DSE in differentiating TS-LGAS patients with preserved LVEF. We investigated the clinical utility of DSE in LGAS patients with preserved LVEF and the echocardiographic determinants suggestive of TS-LGAS. 130 consecutive LGAS patients [indexed aortic valve area (AVA) ≤ 0.6cm/m and mean trans-aortic pressure gradient (PG) < 40mmHg] with preserved (≥ 50%, n = 63) and reduced (< 50%, n = 67) LVEF were included. DSE defined TS-LGAS (projected AVA ≤ 1 cm) in 61.2% patients with reduced LVEF and in 68.3% patients with preserved LVEF. Multivariate logistic regression analysis showed that baseline AVA was an independent determinant of TS-LGAS both in LVEF ≥ 50% (OR 0.45, P = 0.004) and LVEF < 50% groups (OR 0.55, P = 0.005). Reduced septal and lateral mitral annular plane systolic excursion (MAPSE, OR 0.72 and 0.75, P = 0.013 and 0.016) and septal TDI-s´ were significantly associated with TS-LGAS in patients with LVEF ≥ 50%. Higher systolic pulmonary artery pressure (SPAP, OR 1.43, P = 0.045) was associated with TS-LGAS in patients with LVEF < 50%. DSE is useful to define TS-LGAS also in patients with preserved LVEF. Lower baseline AVA values are linked with TS-LGAS in both patients with reduced and preserved LVEF. Reduced MAPSE and septal TDI-s´ are suggestive of TS-LGAS in patients with preserved LVEF, while higher SPAP is associated with TS-LGAS in patients with reduced LVEF.
低剂量多巴酚丁胺负荷超声心动图（DSE）是鉴别左心室射血分数（LVEF）降低患者中真性重度（TS）与假性重度（PS）低跨瓣压差主动脉瓣狭窄（LGAS）的重要工具。然而，仅有少量研究报道了DSE在鉴别LVEF保留的TS-LGAS患者中的临床应用价值。我们研究了DSE在LVEF保留的LGAS患者中的临床应用价值以及提示TS-LGAS的超声心动图决定因素。纳入了130例连续的LGAS患者[主动脉瓣面积指数（AVA）≤0.6cm/m²且平均跨主动脉压力阶差（PG）<40mmHg]，其中LVEF保留（≥50%，n = 63）和降低（<50%，n = 67）的患者。DSE在LVEF降低的患者中诊断出TS-LGAS（预计AVA≤1cm）的比例为61.2%，在LVEF保留的患者中为68.3%。多因素逻辑回归分析显示，基线AVA在LVEF≥50%组（OR 0.45，P = 0.004）和LVEF<50%组（OR 0.55，P = 0.005）中均是TS-LGAS的独立决定因素。在LVEF≥50%的患者中，室间隔和外侧二尖瓣环平面收缩期位移（MAPSE）降低（OR 0.72和0.75，P = 0.013和0.016）以及室间隔组织多普勒s´与TS-LGAS显著相关。在LVEF<50%的患者中，较高的收缩期肺动脉压（SPAP，OR 1.43，P = 0.045）与TS-LGAS相关。DSE在LVEF保留的患者中也有助于诊断TS-LGAS。在LVEF降低和保留的患者中，较低的基线AVA值均与TS-LGAS相关。在LVEF保留的患者中，MAPSE降低和室间隔TDI-s´提示TS-LGAS，而在LVEF降低的患者中，较高的SPAP与TS-LGAS相关。
