心血管合并症对主动脉瓣狭窄患者超声心动图参数的影响。

Impact of cardiovascular comorbidities on echocardiographic parameters in aortic stenosis.

作者信息

Lemek Tomasz A, Garbacz Jakub, Priadka Adam, Roczniak Jan, Dziewierz Artur, Rajzer Marek, Bartuś Stanisław, Surdacki Andrzej, Wieczorek-Surdacka Ewa, Chyrchel Michał

机构信息

Students' Scientific Group, Second Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland.

Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland.

出版信息

Postepy Kardiol Interwencyjnej. 2025 Jun 4;21(2):203-210. doi: 10.5114/aic.2025.151822. eCollection 2025 Jun.

DOI:10.5114/aic.2025.151822

PMID:40656170

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12244350/

Abstract

INTRODUCTION

Comorbidities in aortic stenosis (AS) significantly impact treatment outcomes by influencing intervention timing, choice, and prognosis. Diseases affecting cardiac hemodynamics independently of AS progression may distort echocardiographic interpretation, risking misclassification of AS severity. Understanding how comorbidities alter key echocardiographic parameters may facilitate more precise evaluation.

AIM

To assess the impact of common cardiovascular comorbidities on echocardiographic evaluation of AS.

MATERIAL AND METHODS

Medical records of 234 hospitalized patients with moderate/severe AS were retrospectively analyzed. Exclusion criteria included acute myocardial infarction, prior valvular surgery, and congenital heart defects. All patients underwent standard echocardiographic assessment during hospitalization.

RESULTS

Among the 234 patients (median age 76, 47.4% female), 85.0% had severe AS. The most prevalent comorbidities were hypertension (82.5%), chronic kidney disease (CKD, 45.3%), and type 2 diabetes (T2DM, 39.7%). Atrial fibrillation (AF) occurred in 33.8%, predominantly paroxysmal (49.4%). AF was associated with lower aortic valve mean pressure gradient (AVGmean, = 0.001), peak velocity (Vmax, 0.001), and stroke volume (SV, = 0.01), and higher left atrial (LA) area ( 0.001). T2DM was associated with lower left ventricular ejection fraction (LVEF, = 0.02), higher LA area ( = 0.02), and higher left ventricular mass ( = 0.01). Hypertension correlated with lower AVGmean ( = 0.04). CKD correlated with lower LVEF, AVGmean, SV, and cardiac output ( ≤ 0.02), but higher LA area and E/E' ( ≤ 0.01). Previous myocardial infarction was associated with lower LVEF ( = 0.01), aortic valve area ( = 0.002), SV ( = 0.004), and cardiac output ( 0.001), but higher E/E' ( = 0.01).

CONCLUSIONS

Comorbidities significantly affect echocardiographic parameters in AS, potentially leading to miscategorization of severity. The observed differences highlight a need for more comprehensive evaluation in multimorbid patients.

摘要

引言

主动脉瓣狭窄（AS）合并症通过影响干预时机、选择和预后，对治疗结果产生重大影响。独立于AS进展而影响心脏血流动力学的疾病可能会扭曲超声心动图解释，存在AS严重程度分类错误的风险。了解合并症如何改变关键超声心动图参数可能有助于更精确的评估。

目的

评估常见心血管合并症对AS超声心动图评估的影响。

材料与方法

回顾性分析234例中度/重度AS住院患者的病历。排除标准包括急性心肌梗死、既往瓣膜手术和先天性心脏缺陷。所有患者在住院期间均接受了标准超声心动图评估。

结果

在234例患者（中位年龄76岁，47.4%为女性）中，85.0%患有重度AS。最常见的合并症为高血压（82.5%）、慢性肾脏病（CKD，45.3%）和2型糖尿病（T2DM，39.7%）。房颤（AF）发生率为33.8%，主要为阵发性（49.4%）。AF与较低的主动脉瓣平均压力阶差（AVGmean，=0.001）、峰值速度（Vmax，<0.001）和每搏量（SV，=0.01）以及较高的左心房（LA）面积（<0.001）相关。T2DM与较低的左心室射血分数（LVEF，=0.02）、较高的LA面积（=0.02）和较高的左心室质量（=0.01）相关。高血压与较低的AVGmean（=0.04）相关。CKD与较低的LVEF、AVGmean、SV和心输出量（≤0.02）相关，但与较高的LA面积和E/E'（≤0.01）相关。既往心肌梗死与较低的LVEF（=0.01）、主动脉瓣面积（=0.002）、SV（=0.004）和心输出量（<0.001）相关，但与较高的E/E'（=0.01）相关。