Fukushima Noritoshi, Fukushima Keiko, Sato Hiroki, Saito Chihiro, Uchida Keiko, Yokota Jinko, Ashihara Kyomi, Hagiwara Nobuhisa
Department of Preventive Medicine and Public Health, Tokyo Medical University, Tokyo, Japan.
Department of Cardiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
Heart Vessels. 2019 Sep;34(9):1491-1498. doi: 10.1007/s00380-019-01372-7. Epub 2019 Mar 11.
Proximal aortic enlargement is associated with an increased risk of heart failure and all-cause mortality. Recently, aortic root dilatation (ARD) was reported in postoperative patients with ventricular septal defects (VSDs). However, the impact of ARD on left ventricular (LV) function in postoperative VSD patients remains unclear. Thus, the aim of this study was to investigate the effect of ARD on LV function in patients with postoperative VSD. One hundred and thirty-five patients (> 15 years of age) with surgically repaired isolated ventricular defects and who underwent transthoracic echocardiography in our institution between 2009 and 2013 were identified. ARD was defined as an observed aortic root diameter/body surface area > 2.1 cm/m. The propensity score estimating the probability of having ARD adjusted for anatomical and clinical characteristics was calculated. Forty-four patients (32.6%) had ARD. In unadjusted analyses, right ventricular systolic pressure, Tei index, and E/e' were significantly (p < 0.05) higher in patients with ARD than in those without ARD (31.3 ± 7.5 vs. 35.4 ± 13.7 mmHg, 0.32 ± 0.10 vs. 0.44 ± 0.15, and 7.1 ± 1.7 vs. 9.5 ± 2.9, respectively). In the propensity score-adjusted analysis, significant differences in the Tei index and E/e' were confirmed between the two groups (Tei index difference: 0.11, 95% confidence interval 0.05-0.17; E/e' difference: 2.4, 95% confidence interval 1.3-3.5). However, there were no differences in the other echocardiographic measurements. The presence of ARD in patients with postoperative VSD was significantly associated with LV diastolic dysfunction. Thus, surgically repaired VSD patients require careful screening for aortic enlargement and LV function.
主动脉近端增宽与心力衰竭风险及全因死亡率增加相关。最近，有报道称室间隔缺损（VSD）术后患者出现主动脉根部扩张（ARD）。然而，ARD对VSD术后患者左心室（LV）功能的影响仍不明确。因此，本研究旨在探讨ARD对VSD术后患者LV功能的影响。我们纳入了2009年至2013年间在我院接受手术修复孤立性室间隔缺损且年龄大于15岁并接受经胸超声心动图检查的135例患者。ARD定义为观察到的主动脉根部直径/体表面积>2.1 cm/m²。计算了根据解剖和临床特征调整后的ARD发生概率的倾向评分。44例患者（32.6%）存在ARD。在未校正分析中，ARD患者的右心室收缩压、Tei指数和E/e'显著高于无ARD患者（分别为31.3±7.5 vs. 35.4±13.7 mmHg、0.32±0.10 vs. 0.44±0.15、7.1±1.7 vs. 9.5±2.9，p<0.05）。在倾向评分校正分析中，两组间Tei指数和E/e'存在显著差异（Tei指数差异：0.11，95%置信区间0.05 - 0.17；E/e'差异：2.4，95%置信区间1.3 - 3.5）。然而，其他超声心动图测量指标无差异。VSD术后患者存在ARD与LV舒张功能障碍显著相关。因此，接受手术修复的VSD患者需要仔细筛查主动脉增宽和LV功能。
