Dehghani Payam, Singer Zachary, Morrison Jamie, Booker Jeffery, Lavoie Andrea, Zimmermann Rodney, Basran Paul, Webb John G, Cheema Asim N, Pibarot Phillippe, Clavel Marie-Annick
Prairie Vascular Research Network, University of Saskatchewan, Regina, Canada.
College of Medicine, University of Saskatchewan, Regina, Canada.
Int J Cardiol. 2020 Aug 15;313:35-38. doi: 10.1016/j.ijcard.2020.02.053. Epub 2020 Feb 28.
Postextrasystolic potentiation (PESP)-associated augmentation in left ventricular-aorta pressure gradient (LVAoG) observed after incidental premature ventricular contraction (PVC) during resting echocardiography is similar to dobutamine stress echocardiography (DSE)-associated augmentation in LVAoG in patients with low-flow, low-gradient (LF-LG) aortic stenosis (AS). What is not known is whether a similar relationship exists when unintended PVC causes PESP during cardiac catheterization in patients with AS.
We retrospectively reviewed all catheterizations performed for patients with at least moderate AS who had LVAoG assessment. Univariate and multivariate analyses were conducted to determine the predictors of pre- and post-PVC mean LVAoG ≥ 40 mmHg.
Between September 2015 to September 2017, of 140 individuals undergoing cardiac catheterization, 34 met study criteria. Mean pre-PVC gradient was 38.9 ± 22.8 mmHg. All patients exhibited PESP-associated augmentation of LVAoG by an average of 28 ± 12%. In multivariate analysis, the only significant predictor of post-PVC mean LVAoG ≥ 40 mmHg was preserved LV function (OR 6.81; 95% CI 1.41-32.82, p = 0.02). Inability to generate ≥ 40 mmHg of mean LVAoG post-PVC had 100% specificity for nonsevere AS in our observational cohort.
Unintended but interpretable PVCs occurred in one in four patients with AS undergoing cardiac catheterization with measurable hemodynamics. All of our patients with PVCs, regardless of underlying LVEF, exhibited PESP-associated augmentation of LVAoG. Our exploratory analysis suggests that inability to generate ≥40 mmHg of mean LVAoG post-PVC is highly specific for nonsevere AS.
静息超声心动图检查时偶发室性早搏（PVC）后观察到的左心室-主动脉压力阶差（LVAoG）与早搏后增强（PESP）相关的增加，类似于低流量、低压力阶差（LF-LG）主动脉瓣狭窄（AS）患者多巴酚丁胺负荷超声心动图（DSE）相关的LVAoG增加。尚不清楚的是，在AS患者心脏导管检查期间，意外PVC导致PESP时是否存在类似关系。
我们回顾性分析了所有为至少中度AS且进行了LVAoG评估的患者所做的导管检查。进行单因素和多因素分析以确定PVC前后平均LVAoG≥40 mmHg的预测因素。
在2015年9月至2017年9月期间，140例接受心脏导管检查的患者中，34例符合研究标准。PVC前平均压力阶差为38.9±22.8 mmHg。所有患者均表现出与PESP相关的LVAoG平均增加28±12%。多因素分析中，PVC后平均LVAoG≥40 mmHg的唯一显著预测因素是左心室功能保留（OR 6.81；95%CI 1.41-32.82，p=0.02）。在我们的观察队列中，PVC后无法产生≥40 mmHg的平均LVAoG对非重度AS具有100%的特异性。
在进行可测量血流动力学的心脏导管检查的AS患者中，四分之一会出现意外但可解释的PVC。我们所有有PVC的患者，无论基础左心室射血分数如何，均表现出与PESP相关的LVAoG增加。我们的探索性分析表明，PVC后无法产生≥40 mmHg的平均LVAoG对非重度AS具有高度特异性。
