Roger V L, Tajik A J, Reeder G S, Hayes S N, Mullany C J, Bailey K R, Seward J B
Division of Cardiovascular Diseases, Mayo Clinic Rochester, MN 55905, USA.
Mayo Clin Proc. 1996 Feb;71(2):141-9. doi: 10.4065/71.2.141.
To examine the use of Doppler echocardiography in preoperative assessment of aortic stenosis and to determine its effect on subsequent use of hemodynamic cardiac catheterization.
We retrospectively reviewed a consecutive series of 574 adult patients who underwent aortic valve replacement for aortic stenosis between 1990 and 1992 at our institution. The use of Doppler echocardiography and cardiac catheterization and the predictive factors for use of hemodynamic catheterization were analyzed.
After Doppler echocardiography in 423 patients, invasive hemodynamic assessment of the severity of aortic stenosis was performed in only 42% (179 patients). The use of cardiac catheterization declined over time (54% in 1990, 40% in 1991, and 35% in 1992) (P = 0.003), whereas no significant change in the baseline clinical characteristics of the population or in severity of stenosis as determined by Doppler echocardiography occurred during that time. Multivariate analysis identified the following variables as independent predictors of use of cardiac catheterization after Doppler echocardiography: clinically not severe aortic stenosis, mean gradient of less than 50 mm Hg determined by Doppler echocardiography, Doppler-determined aortic valve area of more than 0.8 cm2 or not calculated, attending cardiologist not specialized in echocardiography, and earlier year of assessment.
After Doppler echocardiography, less than 50% of our patients undergoing aortic valve replacement for aortic stenosis have cardiac catheterization preoperatively. The use of cardiac catheterization after Doppler echocardiography--thus, duplication of hemodynamic assessment--declined significantly over time during the study period. Decline in the use of catheterization is related to the degree of diagnostic certainty provided by Doppler echocardiography and to the level of familiarity of the attending cardiologist with the technique.
探讨多普勒超声心动图在主动脉瓣狭窄术前评估中的应用，并确定其对后续血流动力学心脏导管检查使用情况的影响。
我们回顾性分析了1990年至1992年在我院因主动脉瓣狭窄接受主动脉瓣置换术的574例成年患者的连续系列病例。分析了多普勒超声心动图和心脏导管检查的使用情况以及血流动力学导管检查使用的预测因素。
423例患者接受多普勒超声心动图检查后，仅42%（179例患者）进行了主动脉瓣狭窄严重程度的有创血流动力学评估。心脏导管检查的使用随时间下降（1990年为54%，1991年为40%，1992年为35%）（P = 0.003），而在此期间，患者的基线临床特征或多普勒超声心动图确定的狭窄严重程度无显著变化。多因素分析确定以下变量为多普勒超声心动图检查后心脏导管检查使用的独立预测因素：临床主动脉瓣狭窄不严重、多普勒超声心动图测定的平均压差小于50 mmHg、多普勒测定的主动脉瓣面积大于0.8 cm²或未计算、主治心脏病专家非超声心动图专科医生以及评估年份较早。
在接受主动脉瓣狭窄主动脉瓣置换术的患者中，多普勒超声心动图检查后不到50%的患者术前进行了心脏导管检查。在研究期间，多普勒超声心动图检查后心脏导管检查的使用（即血流动力学评估的重复）随时间显著下降。导管检查使用的下降与多普勒超声心动图提供的诊断确定性程度以及主治心脏病专家对该技术的熟悉程度有关。
