Peng Yanren, Hu Huijun, Shu Xiaorong, Lin Yongqing, Huang Weibin, Xu Shuwan, Nie Ruqiong
Department of Cardiovascular Medicine, Sun Yat-sen Memorial Hospital, Guangzhou, China.
Department of Radiology, Sun Yat-sen Memorial Hospital, Guangzhou, Guangdong, China.
Front Cardiovasc Med. 2023 Dec 14;10:1302992. doi: 10.3389/fcvm.2023.1302992. eCollection 2023.
The characteristics of aortic annulus changes in aortic regurgitation (AR) patients are poorly understood, and predictive factors among aortic valve disease are yet to be established.
This study seeks to elucidate the pattern of annular size fluctuations across different cardiac phases in AR patients and to identify predictors for annular enlargement during either systole or diastole in aortic valve diseases.
A retrospective analysis was conducted on 55 patients with severe aortic valve diseases, including 26 patients with aortic stenosis (AS) and 29 with AR, to discern the two groups' contrasting and analogous patterns of annular changes. The patient sample was expanded to 107 to investigate the factors influencing the size of the annulus during different cardiac phases. Based on our findings, patients were then divided into two groups: those with an annulus that is larger during systole (83 patients) and those where the annulus is larger during diastole (24 patients).
Typically, AR patients exhibit a dynamic annulus, with both perimeter and area being largest during mid-systole. These dimensions diminish progressively and then increase again in early diastole, a pattern consistent with observations in AS patients. Among 107 patients, 21% had diastolic enlargement. Systolic measurements would lead to prosthesis undersizing in 17% of these. Male gender and lower systolic annulus minimum relative to body surface area (AnMin index) were predictors of diastolic enlargement, with ROC curve areas of 0.70 and 0.87 for AR and AS, respectively.
Systolic measurements are recommended for AR patients. Gender and the AnMin index are significant predictors, particularly potent in AS patients.
主动脉瓣关闭不全（AR）患者主动脉瓣环变化的特征了解甚少，主动脉瓣疾病的预测因素尚未确立。
本研究旨在阐明AR患者不同心动周期中瓣环大小波动的模式，并确定主动脉瓣疾病患者在收缩期或舒张期瓣环扩大的预测因素。
对55例严重主动脉瓣疾病患者进行回顾性分析，其中包括26例主动脉瓣狭窄（AS）患者和29例AR患者，以辨别两组瓣环变化的异同模式。将患者样本扩大至107例，以研究不同心动周期中影响瓣环大小的因素。根据研究结果，将患者分为两组：收缩期瓣环较大的患者（83例）和舒张期瓣环较大的患者（24例）。
通常，AR患者的瓣环呈动态变化，周长和面积在收缩中期最大。这些尺寸逐渐减小，然后在舒张早期再次增大，这一模式与AS患者的观察结果一致。在107例患者中，21%有舒张期扩大。在这些患者中，17%的收缩期测量会导致假体尺寸过小。男性性别和相对于体表面积的较低收缩期瓣环最小值（AnMin指数）是舒张期扩大的预测因素，AR和AS的ROC曲线面积分别为0.70和0.87。
建议对AR患者进行收缩期测量。性别和AnMin指数是重要的预测因素，在AS患者中尤为显著。
