Daniel W G, Hood W P, Siart A, Hausmann D, Nellessen U, Oelert H, Lichtlen P R
Circulation. 1985 Apr;71(4):669-80. doi: 10.1161/01.cir.71.4.669.
The prognostic significance of a preoperative echocardiographic left ventricular end-systolic dimension (ESD) greater than 55 mm and/or fractional shortening (FS) of 25% or less was evaluated retrospectively in 84 patients who had undergone aortic valve replacement for isolated chronic aortic regurgitation due to various causes. Postoperative survival, improvement in symptoms, and echocardiographic evidence of regression of left ventricular dilatation and hypertrophy were compared between patients with a preoperative ESD greater than 55 mm (category 1) and those with an ESD of 55 mm or less (category 2) and between patients with FS of 25% or less (category 3) and those with FS greater than 25% (category 4). Patients in categories 1 and 3 had a higher preoperative left ventricular end-diastolic dimension (EDD) and cross-sectional area than those in categories 2 and 4, respectively, but their preoperative functional impairment (NYHA class) was similar. There were 13 deaths, only two of which (one early, one late) could be attributed to left ventricular dysfunction. In both, FS was 25% or less and in one ESD was greater than 55 mm. There was a weak association without useful positive predictive value between the echocardiographic variables and postoperative death due to all causes. Among 42 patients with a preoperative ESD greater than 55 mm and/or FS of 25% or less, 33 (79%) were alive at a mean follow-up of 29.5 months. Symptoms improved in all categories of survivors, with the postoperative NYHA class being similar between categories 1 and 2 and between categories 3 and 4. Among 48 survivors with high-quality echocardiograms both before and after surgery, EDD fell in all groups but fell to a lesser extent in category 3 than in category 4. Postoperative cross-sectional area fell to the same level in all categories. Follow-up intervals were similar in all categories. We conclude that in patients undergoing aortic valve replacement for chronic aortic regurgitation, a preoperative ESD greater than 55 mm or an FS of 25% or less does not reliably predict early or late death, does not correlate with lack of improvement in symptoms, and does not preclude postoperative regression of left ventricular dilatation and hypertrophy. Thus these echocardiographic criteria alone cannot be used for the timing of surgical intervention in these patients.
对84例因各种原因接受单纯慢性主动脉瓣反流主动脉瓣置换术的患者，回顾性评估术前超声心动图测得的左心室收缩末期内径（ESD）大于55mm和/或缩短分数（FS）为25%及以下的预后意义。比较术前ESD大于55mm（1类）和ESD为55mm及以下（2类）的患者以及FS为25%及以下（3类）和FS大于25%（4类）的患者术后生存率、症状改善情况以及左心室扩张和肥厚消退的超声心动图证据。1类和3类患者术前左心室舒张末期内径（EDD）和横截面积分别高于2类和4类患者，但他们术前的功能损害（纽约心脏协会分级）相似。共有13例死亡，其中仅2例（1例早期，1例晚期）可归因于左心室功能障碍。这两例患者的FS均为25%及以下，其中1例ESD大于55mm。超声心动图变量与所有原因导致的术后死亡之间存在弱关联，但无有用的阳性预测价值。在术前ESD大于55mm和/或FS为25%及以下的42例患者中，33例（79%）在平均29.5个月的随访时仍存活。所有存活类别患者的症状均有改善，1类和2类之间以及3类和4类之间术后纽约心脏协会分级相似。在术前和术后均有高质量超声心动图的48例存活患者中，所有组的EDD均下降，但3类比4类下降幅度小。所有类别术后横截面积均降至相同水平。所有类别随访间隔相似。我们得出结论，对于接受慢性主动脉瓣反流主动脉瓣置换术的患者，术前ESD大于55mm或FS为25%及以下不能可靠预测早期或晚期死亡，与症状改善不佳无关，也不排除术后左心室扩张和肥厚的消退。因此，仅这些超声心动图标准不能用于这些患者手术干预的时机选择。
