Percy R F, Miller A B, Conetta D A
Division of Cardiology, University of Florida Health Science Center, Jacksonville.
Am Heart J. 1993 Jan;125(1):151-5. doi: 10.1016/0002-8703(93)90068-k.
Sensitive indexes for detection of left ventricular (LV) systolic performance are necessary for optimal clinical management of asymptomatic patients with aortic regurgitation (AR). To investigate the prognostic value of noninvasively determined baseline LV wall stress, we studied 10 asymptomatic patients with AR who had normal LV systolic function on two-dimensional directed M-mode echocardiography at rest and after maximal treadmill exercise. At follow-up (mean 3.6 years) three patients (group A) had progressed to decompensated LV volume overload or death related to aortic valve disease (one cardiac death and two aortic valve replacements), and seven patients (group B) remained unchanged clinically and on serial echocardiographic study. Although baseline LV chamber dimensions and systolic performance at rest were similar in the two groups of patients, LV fractional shortening after exercise and LV wall stress at rest and after exercise were significantly different (p = 0.02). Noninvasively determined baseline LV wall stress at rest and after exercise may be useful indexes for determining prognosis in asymptomatic AR.
对于无症状主动脉瓣反流（AR）患者的最佳临床管理而言，检测左心室（LV）收缩功能的敏感指标是必要的。为了研究无创测定的基线左心室壁应力的预后价值，我们研究了10例无症状AR患者，这些患者在静息和最大运动平板运动后二维定向M型超声心动图显示左心室收缩功能正常。随访（平均3.6年）时，3例患者（A组）进展为失代偿性左心室容量超负荷或与主动脉瓣疾病相关的死亡（1例心源性死亡和2例主动脉瓣置换），7例患者（B组）临床状况和系列超声心动图检查均无变化。尽管两组患者静息时的基线左心室腔大小和收缩功能相似，但运动后左心室缩短分数以及静息和运动后的左心室壁应力有显著差异（p = 0.02）。无创测定的静息和运动后的基线左心室壁应力可能是确定无症状AR患者预后的有用指标。
