Nitta M, Takamoto T, Taniguchi K, Hultgren H N
Second Department of Internal Medicine, Tokyo Medical and Dental University, Japan.
Jpn Heart J. 1988 Mar;29(2):169-78. doi: 10.1536/ihj.29.169.
Forty-four male patients (mean age 63.6 years) with aortic stenosis (AS) were evaluated by conventional hemodynamic methods and continuous wave (CW) Doppler echocardiography. The relationship between Doppler mean gradients and direct mean pressure gradients in all patients was significant, with an r value of 0.88. Sixteen of 17 patients with a mean Doppler gradient greater than or equal to 40 mmHg had severe AS (AVA less than or equal to 1.0 cm2). Twenty-seven patients had a Doppler gradient less than 40 mmHg, and 8 of these patients had severe AS (AVA less than or equal to 1.0 cm2). The sensitivity and specificity of a Doppler gradient greater than or equal to 40 mmHg in detecting severe AS were, therefore, 67% and 95%, respectively. Thirty-three percent (8/24) of patients with severe AS and low Doppler gradients (less than 40 mmHg) had evidence of poor left ventricular function, evidenced by a lower cardiac output, a higher heart rate and an abnormal PEP/LVET ratio compared to the other patients. Thus, the presence of a low stroke volume less than or equal to 60 ml/beat and PEP/LVET x HR greater than 26 is of value in identifying patients where the Doppler is likely to significantly underestimate the degree of aortic stenosis.
44例男性主动脉瓣狭窄（AS）患者（平均年龄63.6岁）接受了传统血流动力学方法及连续波（CW）多普勒超声心动图评估。所有患者中，多普勒平均压差与直接平均压力差之间的关系显著，r值为0.88。17例平均多普勒压差大于或等于40 mmHg的患者中有16例患有重度AS（主动脉瓣口面积[AVA]小于或等于1.0 cm²）。27例患者的多普勒压差小于40 mmHg，其中8例患有重度AS（AVA小于或等于1.0 cm²）。因此，多普勒压差大于或等于40 mmHg检测重度AS的敏感性和特异性分别为67%和95%。与其他患者相比，重度AS且多普勒压差较低（小于40 mmHg）的患者中有33%（8/24）存在左心室功能不良的证据，表现为心输出量较低、心率较高以及PEP/LVET比值异常。因此，存在每搏量小于或等于60 ml/次且PEP/LVET×心率大于26对于识别多普勒可能显著低估主动脉瓣狭窄程度的患者具有重要价值。
