Lacalzada-Almeida Juan, Izquierdo-Gómez María Manuela, Laynez-Cerdeña Ignacio, Duque-González Amelia, Pérez de Isla Leopoldo, Baeza-Garzón Flor, Jiménez Sosa Alejandro, Marí-López Belén
Cardiology Department, Hospital Universitario de Canarias, Tenerife, ESP.
Cardiology Department, Hospital Clinico de San Carlos, Madrid, ESP.
Cureus. 2021 Sep 25;13(9):e18266. doi: 10.7759/cureus.18266. eCollection 2021 Sep.
Introduction The clinical behavior and prognosis of patients with asymptomatic paradoxical low-gradient aortic stenosis (PLGAS) still remain controversial. Some authors consider PLGAS as an echocardiographically poorly quantified moderate AS (MAS). We aimed to investigate the clinical behavior of PLGAS by comparing it with that of asymptomatic high-gradient aortic stenosis (HG-AS) and MAS using transthoracic echocardiography (TTE) with speckle tracking imaging (STI) and cardiopulmonary exercise testing (CPET). The hypothesis of our study is, unlike that described by other authors, to demonstrate the existence of clinical and echocardiographic differences between PLGAS and MAS. Methods A cohort of 113 patients was included and categorized into three groups according to AS type: MAS (n=63), HG-AS (n=29), and PLGAS (n=21). Patients' clinical data were obtained. Patients underwent 2D TTE with STI and CPET. Results There were no significant differences in the clinical variables between the three AS groups. In the multivariate multinomial logistic regression analysis, with PLGAS being the reference category, the most powerful variable for establishing a difference with HG-AS was the left ventricular mass (LVM) indexed by body-surface area (odds ratio [OR]=1.04, confidence interval (CI)=1.01-1.06, p<0.05). The MAS group showed less abnormal CPET (OR=0.198, CI=0.06-0.69, p<0.05), and higher left ventricle global longitudinal strain rate (GLSR) (OR=0.003, CI=0.00-0.35, p<0.05) than the PLGAS group. Conclusions TTE with STI and CPET established the clear differences between patients with asymptomatic PLGAS and those with asymptomatic MAS, as well as the similarities between patients with PLGAS and those with HG-AS. Our data identify PLGAS as a completely different entity from MAS.
引言 无症状矛盾性低梯度主动脉瓣狭窄（PLGAS）患者的临床行为和预后仍存在争议。一些作者认为PLGAS是一种超声心动图难以准确量化的中度主动脉瓣狭窄（MAS）。我们旨在通过经胸超声心动图（TTE）结合斑点追踪成像（STI）和心肺运动试验（CPET），将PLGAS与无症状高梯度主动脉瓣狭窄（HG-AS）和MAS进行比较，以研究PLGAS的临床行为。我们研究的假设是，与其他作者所描述的不同，证明PLGAS和MAS之间存在临床和超声心动图差异。方法 纳入113例患者，根据主动脉瓣狭窄类型分为三组：MAS（n = 63）、HG-AS（n = 29）和PLGAS（n = 21）。获取患者的临床资料。患者接受二维TTE检查，同时进行STI和CPET。结果 三组主动脉瓣狭窄患者的临床变量无显著差异。在多变量多项逻辑回归分析中，以PLGAS作为参考类别，与HG-AS产生差异的最有力变量是体表面积指数化的左心室质量（LVM）（比值比[OR]=1.04，置信区间（CI）=1.01-1.06，p<0.05）。MAS组的CPET异常情况少于PLGAS组（OR=0.198，CI=0.06-0.69，p<0.05），且左心室整体纵向应变率（GLSR）高于PLGAS组（OR=0.003，CI=0.00-0.35，p<0.05）。结论 TTE结合STI和CPET明确了无症状PLGAS患者与无症状MAS患者之间的差异，以及PLGAS患者与HG-AS患者之间的相似性。我们的数据表明PLGAS是一种与MAS完全不同的疾病实体。
