Department of Cardiology, Ramón y Cajal University Hospital, CIBER CV, Ctra, Colmenar Km 9,100, 28034, Madrid, Spain.
Department of Cardiology, University Hospital, Salamanca, Spain.
J Echocardiogr. 2022 Dec;20(4):216-223. doi: 10.1007/s12574-022-00577-6. Epub 2022 May 17.
The management of patients with asymptomatic significant aortic regurgitation (sAR) is often challenging and appropriate timing of aortic valve surgery remains controversial. Prognostic value of diastolic parameters has been demonstrated in several cardiac diseases. The aim of this study was to analyze the prognostic significance of the diastolic function evaluated by echocardiography, in asymptomatic patients with sAR.
A total of 126 patients with asymptomatic sAR evaluated in the Heart Valve Clinic were retrospective included. Conventional echocardiographic systolic and diastolic function parameters were assessed. Left atrial (LA) auto-strain analysis was performed in a sub-group of 57 patients. A combined end-point of hospital admission due to heart failure, cardiovascular mortality, or aortic valve surgery was defined.
During a median follow-up of 34.1 (interquartile range 16.5-48.1) months, 25 (19.8%) patients reached the combined end-point. Univariate analysis showed that LV volumes, LV ejection fraction (LVEF), LV-GLS, E wave, E/e' ratio, LA volume and LA reservoir strain (LASr) were significant predictors of events. Multivariate analysis that tested all classical echocardiographic variables statistically significant in the univariate model showed that LVEDV (HR = 1.02; 95% CI 1.01-1.03; p < 0.001) and E/e' ratio (HR = 1.12; 95% CI 1.03-123; p = 0.01) were significant predictors of events. Kaplan-Meier curve, stratified by median value of LASr, showed that lower LASr values (less than median of 34%) were associated with higher rates of events (p = 0.013).
In this population of asymptomatic patients with sAR and normal LV systolic function, baseline diastolic parameters were prognostic markers of cardiovascular events; among them, LASr played a significant predictor role.
无症状严重主动脉瓣反流（sAR）患者的管理往往具有挑战性，主动脉瓣手术的适当时机仍存在争议。舒张功能参数在几种心脏疾病中的预后价值已得到证实。本研究旨在分析超声心动图评估的舒张功能在无症状 sAR 患者中的预后意义。
回顾性纳入在心脏瓣膜门诊评估的 126 例无症状 sAR 患者。评估了常规超声心动图收缩和舒张功能参数。在 57 例亚组患者中进行左心房（LA）自动应变分析。定义了因心力衰竭、心血管死亡率或主动脉瓣手术而住院的联合终点。
在中位数为 34.1（四分位距 16.5-48.1）个月的随访期间，25 例（19.8%）患者达到了联合终点。单因素分析显示，LV 容积、LV 射血分数（LVEF）、LV-GLS、E 波、E/e' 比值、LA 容积和 LA 储备应变（LASr）是事件的显著预测因素。在单因素模型中具有统计学意义的所有经典超声心动图变量的多变量分析显示，LVEDV（HR=1.02；95%CI 1.01-1.03；p<0.001）和 E/e' 比值（HR=1.12；95%CI 1.03-123；p=0.01）是事件的显著预测因素。根据 LASr 中位数分层的 Kaplan-Meier 曲线显示，较低的 LASr 值（低于中位数 34%）与更高的事件发生率相关（p=0.013）。
在无症状 sAR 且左心室收缩功能正常的患者中，基线舒张参数是心血管事件的预后标志物；其中，LASr 发挥了重要的预测作用。
