Szabó István Adorján, Gargani Luna, Morvai-Illés Blanka, Polestyuk-Németh Nóra, Frigy Attila, Varga Albert, Ágoston Gergely
GE Palade University of Medicine, Pharmacy, Science and Technology of Tîrgu Mure, Tîrgu Mure, Romania.
Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy.
Front Physiol. 2022 Apr 5;13:838479. doi: 10.3389/fphys.2022.838479. eCollection 2022.
Aortic stenosis (AS) is the most common primary valve lesion requiring intervention in Europe and North America. It has a prolonged subclinical period during which, as AS worsens, left ventricular adaptation becomes inadequate and impaired systolic and/or diastolic dysfunction may lead to overt heart failure (HF). The development of HF is an inflexion point in the natural history of AS. Pulmonary congestion is a cardinal feature in HF, and lung ultrasound (LUS) evaluation of B-lines has been proposed as a simple, noninvasive tool to assess pulmonary congestion. To assess the presence and the prognostic value of sonographic pulmonary congestion in patients with moderate or severe AS. 75 consecutive patients (39 women, mean age 73.85 ± 7.7 years) with moderate or severe AS were enrolled. All patients underwent comprehensive echocardiography and LUS with the 28 scanning-site assessment. Patients were followed-up for 13.4 ± 6 months to establish the prognostic value of LUS. A composite endpoint of death (of any cause), hospitalization for HF and intensification of loop diuretic therapy was considered. We found a severe degree of B-lines (≥30) in 29.33% of patients. The number of B-lines correlated with the estimated pulmonary artery systolic pressure ( < 0.001, r = 0.574) and increased along with NYHA class ( < 0.05, rho = 0.383). At multivariable analysis, B-lines ≥30, and mean gradient were the independent predictors of events [B-lines: 2.79 (CI 1.03-7.54), = 0.04; mean gradient: 1.04 (CI 1.01-1.07), = 0.004]. Evaluation of B-lines is a simple, highly feasible method to detect pulmonary congestion in AS. The number of B-lines correlates with the hemodynamic changes caused by AS and with the functional status of patients. A severe degree of sonographic pulmonary congestion is associated with an increased risk of adverse events.
在欧洲和北美，主动脉瓣狭窄（AS）是最常见的需要干预的原发性瓣膜病变。它有一个较长的亚临床期，在此期间，随着AS病情加重，左心室适应性变得不足，收缩和/或舒张功能障碍可能导致明显的心衰（HF）。心衰的发生是AS自然病程中的一个转折点。肺充血是心衰的一个主要特征，肺超声（LUS）对B线的评估已被提议作为一种评估肺充血的简单、非侵入性工具。为了评估中重度AS患者超声肺充血的存在情况及其预后价值。纳入了75例连续的中重度AS患者（39例女性，平均年龄73.85±7.7岁）。所有患者均接受了全面的超声心动图检查和采用28个扫描部位评估的LUS检查。对患者进行了13.4±6个月的随访，以确定LUS的预后价值。考虑了一个由任何原因导致的死亡、因心衰住院和襻利尿剂治疗强化组成的复合终点。我们发现29.33%的患者存在重度B线（≥30条）。B线数量与估计的肺动脉收缩压相关（<0.001，r = 0.574），并随纽约心脏协会（NYHA）心功能分级增加（<0.05，rho = 0.383）。在多变量分析中，B线≥30条和平均压差是事件的独立预测因素[B线：2.79（CI 1.03 - 7.54），P = 0.04；平均压差：1.04（CI 1.01 - 1.07），P = 0.004]。对B线的评估是一种检测AS患者肺充血的简单、高度可行的方法。B线数量与AS引起的血流动力学变化以及患者的功能状态相关。超声肺充血重度与不良事件风险增加相关。
