Adda Jérôme, Stanova Viktoria, Habib Gilbert, Rieu Régis
Department of Cardiology, Polyclinique les Fleurs, 83190 Ollioules, France.
Aix-Marseille University, Gustave Eiffel University, LBA-UMRT24, Marseille, France.
J Cardiol. 2021 Apr;77(4):334-340. doi: 10.1016/j.jjcc.2020.08.003. Epub 2020 Sep 18.
Planimetry of aortic stenosis can be performed when Doppler measurements are unavailable. We sought to evaluate if, as advised in guidelines, the geometric orifice area (GOA) threshold value of 1 cm² was concordant with the threshold of 1 cm² of the effective orifice area (EOA), and the factors influencing the contraction coefficient (EOA/GOA ratio).
In an in vitro mock circulatory system, we tested 6 degrees of AS severity (3 severe and 3 non-severe), and 3 levels of flow (<150 ml/s, 150-200 ml/s, >250 ml/s). The EOA was calculated by Doppler-echocardiography, and the GOA was measured with dedicated software after camera acquisition.
In all but the very low flow condition, an EOA of 1 cm² corresponded to a GOA of 1.2 cm². The contraction coefficient increased with both the flow and the stenosis severity. For very severe stenoses, the EOA and the GOA were interchangeable.
As observed in clinical studies, the GOA was larger than the EOA, and a GOA between 1 and 1.2 cm² should not discard the possibility of severe aortic stenosis.
当无法进行多普勒测量时，可对主动脉瓣狭窄进行平面测量。我们试图评估，如指南中所建议的，几何开口面积（GOA）的1平方厘米阈值是否与有效开口面积（EOA）的1平方厘米阈值一致，以及影响收缩系数（EOA/GOA比值）的因素。
在体外模拟循环系统中，我们测试了6度主动脉瓣狭窄严重程度（3度重度和3度非重度）以及3个血流水平（<150毫升/秒、150 - 200毫升/秒、>250毫升/秒）。通过多普勒超声心动图计算EOA，并在图像采集后使用专用软件测量GOA。
除极低血流情况外，在所有情况下，1平方厘米的EOA对应1.2平方厘米的GOA。收缩系数随血流和狭窄严重程度增加。对于极重度狭窄，EOA和GOA是可互换的。
正如临床研究中所观察到的，GOA大于EOA，1至1.2平方厘米之间的GOA不应排除重度主动脉瓣狭窄的可能性。
