Li Quan, Zuo Wuxu, Liu Yu, Chen Beiqi, Wu Yuanfeng, Dong Lili, Shu Xianhong
Department of Echocardiography, Zhongshan Hospital, Fudan University, 200032 Shanghai, China.
Shanghai Institute of Cardiovascular Diseases, 200032 Shanghai, China.
Rev Cardiovasc Med. 2023 Apr 17;24(4):114. doi: 10.31083/j.rcm2404114. eCollection 2023 Apr.
Predicting outcomes of surgical aortic valve replacement (AVR) in patients with chronic severe aortic regurgitation (AR) and markedly reduced left ventricular (LV) function remains a challenge. This study aimed to explore the preoperative echocardiographic index that could predict the recovery of LV systolic function after surgery in patients with chronic severe AR and reduced left ventricular ejection fraction (LVEF).
The study group consisted of 50 patients diagnosed with chronic severe AR ( 6 months) and significantly reduced LVEF (18~35%, average 26.2 5.3%). Low-dose dobutamine stress echocardiography (DSE) was performed before surgery. Only patients with an absolute increase in LVEF 8% during DSE were referred for surgical AVR. During following up (over six months to one year after surgery), the patients were divided into two groups by postoperative LVEF ( or 40%). DSE- and speckle tracking echocardiography (STE)-derived LV functional parameters were compared between groups to identify predictors of post-operative improvement in LVEF.
A total of 38 patients underwent AVR. One patient died before discharge. Post-surgical LV size and LVEF improved markedly after surgery in all patients (n = 37). Pre-surgical LV end-systolic diameter, baseline global longitudinal strain (GLS) and peak GLS were better in the group with LVEF 40% (n = 18; 0.05, test). Baseline GLS and peak GLS correlated moderately with post-surgery LVEF (R = -0.581, 0.001; R = -0.596, 0.001; respectively). Logistic regression analysis demonstrated baseline GLS and peak GLS were the independent predictors of post-surgery improvement of LVEF. Peak GLS had the highest prediction value (area under the curve = 0.895, sensitivity and specificity: 89.5% and 77.8%, respectively), with a cutoff value of -9.4%.
This study shows that STE combined with DSE can provide sensitive quantitative indices for predicting improvement of LV systolic function after AVR in patients with chronic severe AR and significantly decreased LVEF.
预测慢性重度主动脉瓣反流（AR）且左心室（LV）功能显著降低患者行主动脉瓣置换术（AVR）的预后仍然是一项挑战。本研究旨在探索术前超声心动图指标，以预测慢性重度AR且左心室射血分数（LVEF）降低患者术后左心室收缩功能的恢复情况。
研究组由50例诊断为慢性重度AR（≥6个月）且LVEF显著降低（18%~35%，平均26.2±5.3%）的患者组成。术前进行低剂量多巴酚丁胺负荷超声心动图（DSE）检查。只有在DSE期间LVEF绝对增加≥8%的患者才被推荐行手术AVR。在随访期间（术后6个月至1年），根据术后LVEF（≥或＜40%）将患者分为两组。比较两组之间DSE和斑点追踪超声心动图（STE）得出的左心室功能参数，以确定LVEF术后改善的预测因素。
共有38例患者接受了AVR。1例患者在出院前死亡。所有患者（n = 37）术后左心室大小和LVEF均有明显改善。LVEF≥40%组（n = 18）的术前左心室收缩末期直径、基线整体纵向应变（GLS）和峰值GLS更好（P＜0.05，检验）。基线GLS和峰值GLS与术后LVEF中度相关（R = -0.581，P＜0.001；R = -0.596，P＜0.001）。逻辑回归分析表明基线GLS和峰值GLS是LVEF术后改善的独立预测因素。峰值GLS具有最高的预测价值（曲线下面积 = 0.895，敏感性和特异性分别为89.5%和77.8%），临界值为-9.4%。
本研究表明，STE联合DSE可为预测慢性重度AR且LVEF显著降低患者AVR术后左心室收缩功能改善提供敏感的定量指标。
