Kočková Radka, Línková Hana, Hlubocká Zuzana, Mědílek Karel, Tuna Martin, Vojáček Jan, Skalský Ivo, Černý Štěpán, Malý Jiří, Hlubocký Jaroslav, Mizukami Takuya, De Colle Cristina, Pěnička Martin
Cardiothoracic Surgery Department, Na Homolce Hospital, Czech Republic (R.K., I.S., S.C.).
Department of Cardiology, Royal Vinohrady University Hospital, Czech Republic (H.L.).
Circ Cardiovasc Imaging. 2022 Dec;15(12):e014901. doi: 10.1161/CIRCIMAGING.122.014901. Epub 2022 Dec 20.
Use of the current echocardiography-based indications for aortic regurgitation (AR) surgery might result in late valve replacement at the stage of irreversible myocardial damage. Therefore, we aimed to identify simple models combining multiple echocardiography or magnetic resonance imaging (MRI)-derived indices and natriuretic peptides (BNP [brain natriuretic peptide] or NT-proBNP [N-terminnal pro-B type natriuretic peptide]) to predict early disease decompensation in asymptomatic severe AR.
This prospective and multicenter study included asymptomatic patients with severe AR, preserved left ventricular ejection fraction (>50%), and sinus rhythm. The echocardiography and MRI images were analyzed centrally in the CoreLab. The study end point was the onset of indication for aortic valve surgery as per current guidelines.
The derivative cohort consisted of 127 asymptomatic patients (age 45±14 years, 84% males) with 41 (32%) end points during a median follow-up of 1375 (interquartile range, 1041-1783) days. In multivariable Cox regression analysis, age, BNP, 3-dimensional vena contracta area, MRI left ventricular end-diastolic volume index, regurgitant volume, and a fraction were identified as independent predictors of end point (all <0.05). However, a combined model including one parameter of AR assessment (MRI regurgitant volume or regurgitant fraction or 3-dimensional vena contracta area), 1 parameter of left ventricular remodeling (MRI left ventricular end-diastolic volume index or echocardiography 2-dimensional global longitudinal strain or E wave), and BNP showed significantly higher predictive accuracy (area under the curve, 0.74-0.81) than any parameter alone (area under the curve, 0.61-0.72). These findings were confirmed in the validation cohort (n=100 patients, 38 end points).
In asymptomatic severe AR, multimodality and multiparametric model combining 2 imaging indices with natriuretic peptides, showed high accuracy to identify early disease decompensation. Further prospective studies are warranted to explore the clinical benefit of implementing these models to guide patient management.
URL: https://www.
gov; Unique identifier: NCT02910349.
目前基于超声心动图的主动脉瓣反流（AR）手术指征的应用可能会导致在心肌损伤不可逆阶段进行晚期瓣膜置换。因此，我们旨在确定结合多种超声心动图或磁共振成像（MRI）衍生指标与利钠肽（BNP[脑钠肽]或NT-proBNP[N末端前B型利钠肽原]）的简单模型，以预测无症状重度AR患者的早期疾病失代偿。
这项前瞻性多中心研究纳入了无症状的重度AR患者，其左心室射血分数保留（>50%）且为窦性心律。超声心动图和MRI图像在核心实验室进行集中分析。研究终点是根据当前指南确定的主动脉瓣手术指征的出现。
衍生队列包括127例无症状患者（年龄45±14岁，84%为男性），在中位随访1375天（四分位间距，1041 - 1783天）期间有41例（32%）达到终点。在多变量Cox回归分析中，年龄、BNP、三维缩流颈面积、MRI左心室舒张末期容积指数、反流容积和反流分数被确定为终点的独立预测因素（均P<0.05）。然而，一个包含AR评估的一个参数（MRI反流容积或反流分数或三维缩流颈面积）、左心室重构的一个参数（MRI左心室舒张末期容积指数或超声心动图二维整体纵向应变或E波）和BNP的联合模型显示出比任何单个参数（曲线下面积，0.61 - 0.72）显著更高的预测准确性（曲线下面积，0.74 - 0.81）。这些发现在验证队列（n = 100例患者，38例终点）中得到证实。
在无症状重度AR患者中，结合两种成像指标与利钠肽的多模态和多参数模型在识别早期疾病失代偿方面具有很高的准确性。有必要进行进一步的前瞻性研究，以探索应用这些模型指导患者管理的临床益处。
网址：https://www.
gov；唯一标识符：NCT02910349。
