Barbieri Andrea, Bartolacelli Ylenia, Bursi Francesca, Manicardi Marcella, Boriani Giuseppe
Division of Cardiology, Department of Diagnostics, Clinical and Public Health Medicine, Policlinico University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy.
Division of Cardiology, Heart and Lung Department, San Paolo Hospital, ASST Santi Paolo and Carlo, University of Milan, Milan, Italy.
Echocardiography. 2019 Apr;36(4):639-650. doi: 10.1111/echo.14299. Epub 2019 Mar 4.
To assess prevalence and clinical implications of left ventricular (LV) remodeling considering: LV volume, mass and relative wall thickness at the time of aortic valve stenosis diagnosis.
We retrospectively analyzed 343 patients (age 79.2 ± 9.5 years, 48.1% males) with functional aortic valve area (AVA) ≤ 1.5 cm . LV geometric patterns and clinical outcomes (combined death, cardiac hospitalization, aortic valve replacement [AVR]) were evaluated. According to the new LV remodeling classification, 4.9% had normal geometry, 7.5% concentric remodeling, 39.3% concentric hypertrophy (LVH), 22.4% mixed LVH, 12.5% dilated LVH, 3.2% eccentric LVH and 4.3% eccentric remodeling, 5.5% had not classifiable LVH. Indexed stroke volume (SVi) was higher in patients with concentric LVH (40.3 ± 11.9 mL/m ) and mixed LVH (41.6 ± 13.4 mL/m ) and lower in patients with eccentric LVH (24.9 ± 7.7 mL/m ), concentric (36.6 ± 12.7 mL/m ) and eccentric remodeling (34.9 ± 9.5 mL/m ), P = 0.003. During a median follow-up of 2.2 years, 260 (75.8%) had the combined end point. A significant association between the combined end point and LV dilation (P = 0.010) or LV remodeling patterns (P = 0.0001) was found. After multivariable adjustment for AVR, concentric remodeling (HR 3.12, IC 95% 1.14-8.55; P = 0.02) and dilated LVH (HR 3.48, IC 95% 1.31-9.27; P = 0.01) were strongly associated with death or cardiac hospitalizations.
In patients with AVA ≤ 1.5 cm , when the new LV remodeling classification system is applied, only a minority had normal geometry and less than half had "classic" concentric LVH or remodeling. LV volume dilatation is frequent and associated with adverse outcome. Concentric remodeling, eccentric remodeling, dilated LVH had the worst noninvasive hemodynamic profile and prognosis.
考虑到主动脉瓣狭窄诊断时的左心室（LV）容积、质量和相对壁厚度，评估左心室重构的患病率及其临床意义。
我们回顾性分析了343例功能性主动脉瓣面积（AVA）≤1.5平方厘米的患者（年龄79.2±9.5岁，男性占48.1%）。评估了左心室几何形态模式和临床结局（联合死亡、心脏住院、主动脉瓣置换术[AVR]）。根据新的左心室重构分类，4.9%为正常几何形态，7.5%为向心性重构，39.3%为向心性肥厚（LVH），22.4%为混合性LVH，12.5%为扩张性LVH，3.2%为离心性LVH，4.3%为离心性重构，5.5%为无法分类的LVH。向心性LVH患者（40.3±11.9毫升/平方米）和混合性LVH患者（41.6±13.4毫升/平方米）的指数每搏输出量（SVi）较高，而离心性LVH患者（24.9±7.7毫升/平方米）、向心性（36.6±12.7毫升/平方米）和离心性重构患者（34.9±9.5毫升/平方米）的指数每搏输出量较低，P=0.003。在中位随访2.2年期间，260例（75.8%）达到联合终点。发现联合终点与左心室扩张（P=0.010）或左心室重构模式（P=0.0001）之间存在显著关联。在对AVR进行多变量调整后，向心性重构（HR 3.12，95%置信区间1.14 - 8.55；P=0.02）和扩张性LVH（HR 3.48，95%置信区间1.31 - 9.27；P=0.01）与死亡或心脏住院密切相关。
在AVA≤1.5平方厘米的患者中，应用新的左心室重构分类系统时，只有少数患者具有正常几何形态，不到一半的患者有“经典”的向心性LVH或重构。左心室容积扩张很常见且与不良结局相关。向心性重构、离心性重构、扩张性LVH具有最差的无创血流动力学特征和预后。
