Reimold S C, Orav E J, Come P C, Caguioa E S, Lee R T
Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA.
J Am Soc Echocardiogr. 1998 Mar;11(3):259-65. doi: 10.1016/s0894-7317(98)70087-2.
The severity of aortic regurgitation is dependent on the size of the regurgitant orifice, the left ventricular response to volume overload, and the diastolic pressure difference across the aortic valve. The purpose of this study was to test the hypothesis that the aortic regurgitant orifice increases over time in patients with audible chronic aortic regurgitation. To assess serial changes in aortic regurgitant severity by the use of two-dimensional and Doppler echocardiography, 59 patients (29 men and 30 women) with audible chronic aortic regurgitation were prospectively identified and evaluated annually with two-dimensional and Doppler echocardiograms. Patients were followed for a median of 38 months. We measured two separate indicators of the size of the regurgitant orifice: the color Doppler regurgitant jet width and the Doppler-derived regurgitant orifice area. Jet width increased with time (0.5 +/- 0.4 cm at baseline, 0.04 +/- 0.01 cm/year slope, p < 0.001). The regurgitant orifice area also increased (0.12 +/- 0.14 cm2 at baseline, 0.01 +/- 0.01 cm2/year, p = 0.05). Changes in regurgitant orifice area were related to changes in left ventricular end-diastolic dimension (p < 0.001). There were no significant changes in left ventricular chamber dimensions, volumes, and regurgitant volume over time in this cohort. Increases in jet width and orifice area occurred in patients with all degrees of baseline disease severity, with bicuspid or tricuspid leaflet morphology, and with male or female sex. In this prospective study of chronic aortic regurgitation, both jet width and Doppler-derived regurgitant orifice area increased over time. These findings suggest that one factor in the progression of chronic aortic regurgitation is enlargement of the orifice.
主动脉瓣反流的严重程度取决于反流口的大小、左心室对容量超负荷的反应以及主动脉瓣两端的舒张压差值。本研究的目的是检验以下假设：在有可闻及慢性主动脉瓣反流的患者中，主动脉反流口会随时间增大。为了利用二维和多普勒超声心动图评估主动脉反流严重程度的系列变化，前瞻性地确定了59例（29例男性和30例女性）有可闻及慢性主动脉瓣反流的患者，并每年用二维和多普勒超声心动图进行评估。患者的随访时间中位数为38个月。我们测量了反流口大小的两个独立指标：彩色多普勒反流束宽度和多普勒得出的反流口面积。反流束宽度随时间增加（基线时为0.5±0.4 cm，斜率为0.04±0.01 cm/年，p<0.001）。反流口面积也增加了（基线时为0.12±0.14 cm²，0.01±0.01 cm²/年，p = 0.05）。反流口面积的变化与左心室舒张末期内径的变化相关（p<0.001）。在该队列中，左心室腔的尺寸、容积和反流容积随时间没有显著变化。在所有基线疾病严重程度、有二叶或三叶瓣形态以及不同性别的患者中，反流束宽度和反流口面积均增加。在这项关于慢性主动脉瓣反流的前瞻性研究中，反流束宽度和多普勒得出的反流口面积均随时间增加。这些发现表明，慢性主动脉瓣反流进展的一个因素是反流口扩大。
