严重主动脉瓣狭窄患者主动脉瓣置换前后的循环效率。
Circulatory efficiency in patients with severe aortic valve stenosis before and after aortic valve replacement.
机构信息
Department of Congenital Heart Disease, German Heart Centre Berlin, Berlin, Germany.
Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
出版信息
J Cardiovasc Magn Reson. 2021 Mar 1;23(1):15. doi: 10.1186/s12968-020-00686-0.
BACKGROUND
Circulatory efficiency reflects the ratio between total left ventricular work and the work required for maintaining cardiovascular circulation. The effect of severe aortic valve stenosis (AS) and aortic valve replacement (AVR) on left ventricular/circulatory mechanical power and efficiency is not yet fully understood. We aimed to quantify left ventricular (LV) efficiency in patients with severe AS before and after surgical AVR.
METHODS
Circulatory efficiency was computed from cardiovascular magnetic resonance (CMR) imaging derived volumetric data, echocardiographic and clinical data in patients with severe AS (n = 41) before and 4 months after AVR and in age and sex-matched healthy subjects (n = 10).
RESULTS
In patients with AS circulatory efficiency was significantly decreased compared to healthy subjects (9 ± 3% vs 12 ± 2%; p = 0.004). There were significant negative correlations between circulatory efficiency and LV myocardial mass (r = - 0.591, p < 0.001), myocardial fibrosis volume (r = - 0.427, p = 0.015), end systolic volume (r = - 0.609, p < 0.001) and NT-proBNP (r = - 0.444, p = 0.009) and significant positive correlation between circulatory efficiency and LV ejection fraction (r = 0.704, p < 0.001). After AVR, circulatory efficiency increased significantly in the total cohort (9 ± 3 vs 13 ± 5%; p < 0.001). However, in 10/41 (24%) patients, circulatory efficiency remained below 10% after AVR and, thus, did not restore to normal values. These patients also showed less reduction in myocardial fibrosis volume compared to patients with restored circulatory efficiency after AVR.
CONCLUSION
In our cohort, circulatory efficiency is reduced in patients with severe AS. In 76% of cases, AVR leads to normalization of circulatory efficiency. However, in 24% of patients, circulatory efficiency remained below normal values even after successful AVR. In these patients also less regression of myocardial fibrosis volume was seen. Trial Registration clinicaltrials.gov NCT03172338, June 1, 2017, retrospectively registered.
背景
循环效率反映了左心室总工作量与维持心血管循环所需工作量之间的比值。严重主动脉瓣狭窄（AS）和主动脉瓣置换（AVR）对左心室/循环机械功率和效率的影响尚不完全清楚。我们旨在量化严重 AS 患者手术 AVR 前后左心室（LV）效率。
方法
从严重 AS 患者（n=41）的心血管磁共振（CMR）成像衍生容积数据、超声心动图和临床数据中计算循环效率，并与年龄和性别匹配的健康受试者（n=10）进行比较。
结果
与健康受试者相比，AS 患者的循环效率显著降低（9±3%比 12±2%；p=0.004）。循环效率与 LV 心肌质量（r=-0.591，p<0.001）、心肌纤维化容积（r=-0.427，p=0.015）、收缩末期容积（r=-0.609，p<0.001）和 NT-proBNP（r=-0.444，p=0.009）呈显著负相关，与 LV 射血分数（r=0.704，p<0.001）呈显著正相关。AVR 后，总队列的循环效率显著增加（9±3 比 13±5%；p<0.001）。然而，在 41 例患者中有 10 例（24%），AVR 后循环效率仍低于 10%，因此未恢复正常。与 AVR 后循环效率恢复正常的患者相比，这些患者的心肌纤维化容积减少也较少。
结论
在我们的队列中，严重 AS 患者的循环效率降低。在 76%的病例中，AVR 导致循环效率正常化。然而，在 24%的患者中，即使在成功的 AVR 后，循环效率仍低于正常值。在这些患者中，心肌纤维化容积的减少也较少。
试验注册
clinicaltrials.gov NCT03172338，2017 年 6 月 1 日，回顾性注册。
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