超声对重度主动脉瓣狭窄并充血性心力衰竭患者预后的评估价值

Value of Ultrasound Parameters for the Clinical Symptoms of Severe Heart Failure in Severe Aortic Valve Stenosis

目的:确定在重度主动脉瓣狭窄患者中,与充血性心衰临床症状有关的超声参数。方法:回顾性分析198例射血分数正常的重度主动脉瓣狭窄患者,充血性心衰(CHF)症状按NYHA功能分级进行分类。比较NYHAⅠ~Ⅲ级与NYHAⅣ级患者之间的超声参数。结果:与NYHAⅠ~Ⅲ组相比,NYHAⅣ组患者年龄偏大(P<0.001),左室LVMI偏大(P<0.001),E/A值增高(P<0.001),DT减低(P<0.001),室间隔增厚(P=0.006),EF减低(P=0.010)。多变量回归分析显示,LVMI和DT与NYHAⅣ独立相关。ROC曲线分析显示LVMI≥142g/m^2和DT≤194ms可以提高对主动脉瓣狭窄所致心衰的识别能力。结论:LVMI和DT与NYHAⅣ独立相关。这些超声指标对于确定心衰症状是否由SAS导致很有帮助,并起到评估预后的价值。

Objective: To identify objective and noninvasive ultrasound parameters associated with severe CHF symptoms in SAS. Methods: 198 patients with SAS without left ventricular(LV) dysfunction were retrospectively studied.CHF symptoms were classified by the New York Heart Association(NYHA)functional class.Echo parameters were compared between NYHAⅠ~Ⅲ and NYHAⅣ. Results: Patients with NYHAⅣ were older( P <0.001) and had a larger LV mass index(LVMI)( P <0.001),a higher transmitral flow velocity ratio(E/A)( P <0.001),a shorter deceleration time(DT)( P <0.001),and a thicker IVS thickness ( P =0.006),and a lower EF( P =0.010)than patients with NYHAⅠ~Ⅲ.On multivariable analysis,LVMI and DT were independently associated with NYHA Ⅳ.Receiver operating characteristic curve analysis identified LVMI≥142g/m 2 and DT≤194ms as the cutoff values associated with NYHA Ⅳ in patients with SAS. Conclusion: Left ventricular mass index and DT were independently associated with severe heart failure(NYHA Ⅳ).These echo parameters could be helpful to judge whether CHF symptoms are caused by SAS.