Velders Bart J J, Vriesendorp Michiel D, Asch Federico M, Reardon Michael J, Dagenais Francois, Moront Michael G, Sabik Iii Joseph F, Groenwold Rolf H H, Klautz Robert J M
Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands.
Department of Cardiovascular Core Laboratories, MedStar Health Research Institute, and Georgetown University, Washington, DC.
JTCVS Open. 2024 Mar 19;19:68-90. doi: 10.1016/j.xjon.2024.02.023. eCollection 2024 Jun.
New echocardiographic definitions have been proposed for hemodynamic structural valve deterioration. We aimed to study their consistency in classifying structural valve deterioration after surgical aortic valve replacement.
Data were used of patients undergoing surgical aortic valve replacement in a multicenter, prospective cohort study with a 5-year follow-up. All patients received the same stented bioprosthesis. Echocardiographic parameters were assessed by an independent core laboratory. Moderate or greater stenotic hemodynamic structural valve deterioration was defined according to Capodanno and colleagues, Dvir and colleagues, and the Valve Academic Research Consortium 3; regurgitation data were not considered in this analysis. Consistency was quantified on the basis of structural valve deterioration classification at subsequent time points.
A total of 1118 patients received implants. Patients' mean age was 70 years, and 75% were male. Hemodynamic structural valve deterioration at any visit was present in 51 patients (4.6%), 32 patients (2.9%), and 34 patients (3.0%) according to Capodanno, Dvir, and Valve Academic Research Consortium 3. A total of 1064 patients (95%) were never labeled with structural valve deterioration by any definition. After the first classification with structural valve deterioration, 59%, 59%, and 65% had no subsequent structural valve deterioration classification according to Capodanno, Dvir, and Valve Academic Research Consortium 3, respectively.
The current definitions of hemodynamic structural valve deterioration are strong negative predictors but inconsistent positive discriminators for the detection of stenotic hemodynamic structural valve deterioration. Although the diagnosis of structural valve deterioration may be categorical, echocardiographic indices lack this degree of precision in the first 5 years after surgical aortic valve replacement. The inconsistency of current structural valve deterioration definitions impedes the detection of true valve degeneration, which challenges the clinical usefulness of these definitions.
已提出用于血流动力学结构性瓣膜退变的新超声心动图定义。我们旨在研究这些定义在外科主动脉瓣置换术后结构性瓣膜退变分类中的一致性。
数据来自一项多中心前瞻性队列研究中接受外科主动脉瓣置换术且随访5年的患者。所有患者均接受相同的带支架生物瓣膜。超声心动图参数由独立的核心实验室评估。根据卡波丹诺及其同事、德维尔及其同事以及瓣膜学术研究联盟3的标准，定义为中度或更严重的狭窄性血流动力学结构性瓣膜退变；本分析未考虑反流数据。基于后续时间点的结构性瓣膜退变分类对一致性进行量化。
共有1118例患者接受了植入手术。患者的平均年龄为70岁，75%为男性。根据卡波丹诺、德维尔和瓣膜学术研究联盟3的标准，在任何一次随访中出现血流动力学结构性瓣膜退变的患者分别有51例（4.6%）、32例（2.9%）和34例（3.0%）。共有1064例患者（95%）无论依据何种定义均未被标记为结构性瓣膜退变。在首次被分类为结构性瓣膜退变后，根据卡波丹诺、德维尔和瓣膜学术研究联盟3的标准，分别有59%、59%和65%的患者在后续未被再次分类为结构性瓣膜退变。
目前血流动力学结构性瓣膜退变的定义对于检测狭窄性血流动力学结构性瓣膜退变是强有力的阴性预测指标，但作为阳性判别指标时并不一致。尽管结构性瓣膜退变的诊断可能是明确的，但在外科主动脉瓣置换术后的前5年，超声心动图指标缺乏这种精确程度。当前结构性瓣膜退变定义的不一致性阻碍了对真正瓣膜退变的检测，这对这些定义的临床实用性提出了挑战。
