Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
Division Cardiology, Teine Keijinkai Hospital, Sapporo, Japan.
Echocardiography. 2024 Apr;41(4):e15808. doi: 10.1111/echo.15808.
The assessment of left ventricular (LV) filling pressure (FP) is important for the management of aortic stenosis (AS) patients. Although, it is often restricted for predict LV FP in AS because of mitral annular calcification and a certain left ventricular hypertrophy. Thus, we tested the predictive ability of the algorithm for elevated LV FP in AS patients and also applied a recently-proposed echocardiographic scoring system of LV FP, visually assessed time difference between the mitral valve and tricuspid valve opening (VMT) score.
We enrolled consecutive 116 patients with at least moderate AS in sinus rhythm who underwent right heart catheterization and echocardiography within 7 days. Mean pulmonary artery wedge pressure (PAWP) was measured as invasive parameter of LV FP. LV diastolic dysfunction (DD) was graded according to the ASE/EACVI guidelines. The VMT score was defined as follows: time sequence of opening of mitral and tricuspid valves was scored to 0-2 (0: tricuspid valve first, 1: simultaneous, 2: mitral valve first). When the inferior vena cava was dilated, one point was added and VMT score was finally calculated as 0-3.
Of the 116 patients, 29 patients showed elevated PAWP. Ninety patients (93%) and 67 patients (63%) showed increased values for left atrium volume index (LAVI) and E/e', respectively when the cut-off values recommended by the guidelines were applied and thus the algorism predicted elevated PAWP with a low specificity and positive predictive value (PPV). VMT ≥ 2 predicted elevated PAWP with a sensitivity of 59%, specificity of 90%, PPV of 59%, and negative predictive value of 89%. An alternative algorithm that applied tricuspid regurgitation velocity and VMT scores was tested, and its predictive ability was markedly improved.
VMT score was applicable for AS patients. Alternative use of VMT score improved diagnostic accuracy of guideline-recommended algorism.
评估左心室（LV）充盈压（FP）对于主动脉瓣狭窄（AS）患者的管理很重要。然而，由于二尖瓣环钙化和一定程度的左心室肥厚，通常限制了其在 AS 中预测 LV FP 的能力。因此，我们测试了该算法在 AS 患者中预测 LV FP 升高的能力，并应用了最近提出的 LV FP 超声心动图评分系统，即评估二尖瓣和三尖瓣开口时间差的 VMT 评分。
我们连续纳入了 116 例窦性心律且至少中度 AS 的患者，这些患者在 7 天内行右心导管检查和超声心动图检查。平均肺动脉楔压（PAWP）被测量为 LV FP 的侵入性参数。LV 舒张功能障碍（DD）根据 ASE/EACVI 指南进行分级。VMT 评分定义如下：二尖瓣和三尖瓣的开口时间顺序评分 0-2（0：三尖瓣先开，1：同时开，2：二尖瓣先开）。当下腔静脉扩张时，加 1 分，最后计算 VMT 评分为 0-3。
在 116 例患者中，有 29 例患者的 PAWP 升高。当应用指南推荐的界值时，90 例（93%）和 67 例（63%）患者的左心房容积指数（LAVI）和 E/e'分别升高，因此该算法预测 PAWP 升高的特异性和阳性预测值（PPV）较低。VMT≥2 预测 PAWP 升高的敏感性为 59%，特异性为 90%，PPV 为 59%，阴性预测值为 89%。我们还测试了一种应用三尖瓣反流速度和 VMT 评分的替代算法，其诊断准确性明显提高。
VMT 评分适用于 AS 患者。替代使用 VMT 评分提高了指南推荐算法的诊断准确性。
