Pirwitz M J, Lange R A, Willard J E, Landau C, Glamann D B, Hillis L D
Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas 75235-9047.
J Am Coll Cardiol. 1994 Dec;24(7):1672-7. doi: 10.1016/0735-1097(94)90173-2.
This study was designed to assess the left ventricular peak systolic pressure/end-systolic volume (PSP/ESV) ratio in predicting symptomatic improvement with valve replacement in patients with aortic regurgitation and enlarged left ventricular volume.
Patients with aortic regurgitation and a left ventricular end-systolic volume < or = 60 ml/m2 show symptomatic improvement with valve replacement, whereas the response of those with an enlarged end-systolic volume > 60 ml/m2 is mixed. Most benefit, but some do not. Valve replacement appears to help those whose end-systolic volume is enlarged because of excessive left ventricular afterload but appears to have little or no effect in those whose end-systolic volume is enlarged because of depressed left ventricular contractility.
We studied 27 patients (21 men and 6 women aged 18 to 72 years) with moderate or severe aortic regurgitation, no other cardiovascular abnormalities and left ventricular end-systolic volume > 60 ml/m2. In this group we assessed the ability of preoperative variables routinely measured at cardiac catheterization to predict symptomatic improvement with valve replacement.
Of the 27 subjects, 1 (4%) died 51 days postoperatively. Six months postoperatively, symptoms had lessened in 17 patients (63%), were unchanged in 8 (29%) and had worsened in 1 (4%). By multivariate analysis, the PSP/ESV ratio was the strongest predictor of both functional class 6 months postoperatively (p = 0.026) and change in functional class from before operation to 6 months postoperatively (p = 0.033). By 6 months after valve replacement, all patients with a ratio > or = 1.72 mm Hg/ml per m2 were in functional class I or II; in contrast, of those with a ratio < 1.72 mm Hg/ml per m2, 31% were in functional class III, and 1 (8%) had died.
The PSP/ESV ratio may help to predict which patients with aortic regurgitation and enlarged left ventricular end-systolic volume will have symptomatic improvement with valve replacement.
本研究旨在评估左心室收缩压峰值/收缩末期容积（PSP/ESV）比值在预测主动脉瓣反流且左心室容积增大患者瓣膜置换术后症状改善情况中的作用。
主动脉瓣反流且左心室收缩末期容积≤60 ml/m²的患者瓣膜置换术后症状改善，而收缩末期容积＞60 ml/m²的增大患者反应不一。多数获益，但部分患者无改善。瓣膜置换似乎对因左心室后负荷过重导致收缩末期容积增大的患者有帮助，而对因左心室收缩力降低导致收缩末期容积增大的患者作用甚微或无作用。
我们研究了27例（21例男性和6例女性，年龄18至72岁）中度或重度主动脉瓣反流、无其他心血管异常且左心室收缩末期容积＞60 ml/m²的患者。在该组中，我们评估了心脏导管检查时常规测量的术前变量预测瓣膜置换术后症状改善的能力。
27例受试者中，1例（4%）术后51天死亡。术后6个月，17例患者（63%）症状减轻，8例（29%）症状无变化，1例（4%）症状恶化。多因素分析显示，PSP/ESV比值是术后6个月功能分级（p = 0.026）及术前至术后6个月功能分级变化（p = 0.033）的最强预测指标。瓣膜置换术后6个月时，所有PSP/ESV比值≥1.72 mmHg/ml/m²的患者功能分级为I或II级；相比之下，PSP/ESV比值＜1.72 mmHg/ml/m²的患者中，31%功能分级为III级，1例（8%）死亡。
PSP/ESV比值可能有助于预测哪些主动脉瓣反流且左心室收缩末期容积增大的患者瓣膜置换术后症状会改善。
