无左心室肥厚的重度主动脉瓣狭窄：患病率、预测因素及主动脉瓣置换术后短期随访
Severe aortic stenosis without left ventricular hypertrophy: prevalence, predictors, and short-term follow up after aortic valve replacement.
作者信息
Seiler C, Jenni R
机构信息
Department of Internal Medicine, University Hospital, Bern, Switzerland.
出版信息
Heart. 1996 Sep;76(3):250-5. doi: 10.1136/hrt.76.3.250.
OBJECTIVES
The purpose of the present study in patients with severe aortic stenosis was to assess the prevalence of absent left ventricular hypertrophy (LVH) (determined according to mass criteria), to identify predictors of absent LVH, and to assess short-term left ventricular adaptation and prognosis after aortic valve replacement.
METHODS
Left ventricular mass (LVM) was determined by echocardiography in 109 men and 101 women with severe aortic stenosis (mean pressure gradient < or = 50 mm Hg). LVH was defined as LVM > or = 109 g/m2 in women and LVM > or = 134 g/m2 in men.
RESULTS
One hundred and eighty nine patients showed LVH (group 1) (90%; mean (SD) age 65 (14) years), and 21 showed no LVH (group 2) (10%, age 57 (21) years P = 0.02 for difference in age). Twelve (6%) of those without LVH had increased relative wall thickness (that is, > or = 0.45 with LV concentric remodelling) and nine (4%) showed no macroscopically detectable hypertrophic adaptation. The following variables were associated with the absence of LVH: low body surface area, low body mass index, and increased cardiac index. 76/210 patients were followed up a mean of six months after aortic valve replacement. The frequency of adequate ventricular adaptation to the decreased afterload after aortic valve replacement was higher in patients with LVH than in those without. Mortality six months after aortic valve replacement was lower, but not significantly, in patients with LVH (7.6%) than in those without LVH (12.5%, P = 0.10).
CONCLUSIONS
A tenth of patients with severe aortic stenosis did not develop LVH according to mass criteria; 4% of the patients did not have any macroscopic signs of myocardial adaptation to the pressure overload despite longstanding disease. Small body size was independently associated with lack of LVH according to mass criteria. Six months after aortic valve replacement, ventricular adaptation was more often adequate in patients with LVH than in those without.
目的
本研究旨在评估重度主动脉瓣狭窄患者中左心室肥厚（LVH）缺失（根据质量标准确定）的患病率，确定LVH缺失的预测因素，并评估主动脉瓣置换术后左心室的短期适应性和预后。
方法
通过超声心动图测定109例男性和101例女性重度主动脉瓣狭窄患者（平均压力阶差≤50 mmHg）的左心室质量（LVM）。LVH定义为女性LVM≥10�g/m²，男性LVM≥134 g/m²。
结果
189例患者出现LVH（第1组）（90%；平均（标准差）年龄65（14）岁），21例未出现LVH（第2组）（10%，年龄57（21）岁，年龄差异P = 0.02）。12例（6%）无LVH的患者相对室壁厚度增加（即≥0.45，伴有左心室向心性重构），9例（4%）未显示出宏观可检测到的肥厚适应性。以下变量与LVH缺失相关：低体表面积、低体重指数和增加的心指数。210例患者中有76例在主动脉瓣置换术后平均随访6个月。LVH患者主动脉瓣置换术后心室对后负荷降低的适应性频率高于无LVH患者。LVH患者主动脉瓣置换术后6个月的死亡率较低，但无统计学意义（7.6%），低于无LVH患者（12.5%，P = 0.10）。
结论
根据质量标准，十分之一的重度主动脉瓣狭窄患者未发生LVH；4%的患者尽管患有长期疾病，但没有任何心肌对压力超负荷适应的宏观迹象。小体型与根据质量标准缺乏LVH独立相关。主动脉瓣置换术后6个月，LVH患者的心室适应性比无LVH患者更常见。
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