术前左心房最小容积对主动脉瓣狭窄术后症状的预测价值

Preoperative left atrial minimum volume as an independent predictor of postoperative symptoms in patients with aortic stenosis undertaking surgical aortic valve replacement

目的 探讨术前左心房最小容积(LAVmin)对重度主动脉瓣狭窄(AS)患者外科主动脉瓣置换术(SAVR)后症状的预测能力.方法 入选2011年3月至2017年11月在福建医科大学附属漳州市医院行SAVR的AS患者84例,术前行超声心动图检查测量包括LAVmin指数(LAVmin经体表面积校正得到LAVImin)在内的相关参数,术后进行1年的随访,记录术后1~12个月之间出现的心力衰竭症状.根据术后心力衰竭症状有无,将患者分为两组:术后症状组(20例),术后无症状组(64例).用受试者工作特征(ROC)曲线评估超声心动图相关参数对术后症状的预测能力,采用多元Logistic回归分析评估术后症状的相关因素.结果 两组患者之间,术前左心室容积、左心室射血分数及左心室舒张功能障碍程度均无明显差异.而术前LAVImin,在术后症状组和术后无症状组之间则存在显著差异[(45.1±11.6)ml/m2比(27.1±9.2)ml/m2,P<0.01].ROC曲线分析显示,当LAVImin≥30.3 ml/m2时,ROC曲线下面积最大(0.84,敏感度94.1%,特异度69.6%).在多元Logistic回归分析中,术前LAVImin是AS术后症状的独立预测因子(OR=2.17,95% CI 1.04~2.96,P=0.02).结论 经超声心动图测得的术前LAVImin可作为AS患者SAVR术后症状的预测指标,术前LAVImin≥30.3 ml/m2有助于重度AS行SAVR手术时机的选择.

0bjective To investigate the value of preoperative left atrial minimum volume (LAVmin) on postoperative symptoms in patients with severe aortic stenosis (AS) undertaking surgical aortic valve replacement (SAVR). Methods We prospectively enrolled 84 patients with severe AS who underwent SAVR and were followed up one year after SAVR in Zhangzhou Hospital of Fujian Medical University from March 2011 to November 2017. Echocardiographic parameters including LAVmin index (LAVmin adjusted by body surface area, LAVImin) were measured preoperatively in all patients. Postoperative symptoms of heart failure were recorded from 1 month to 12 months after SAVR. The patients were divided into two groups according to the occurrence of postoperative symptoms: postoperatively symptomatic group (n=20) and asymptomatic group (n=64). The receiver operating characteristic (ROC) curve was calculated to assess the predictive value of echocardiographic parameters on postoperative symptoms. Multiple Logistic regression analysis was used to evaluate the parameters related to postoperative symptoms. Results There were no significant differences in preoperative left ventricular volumes, ejection fraction and the severity of left ventricular diastolic dysfunction by echocardiography between the two groups. There was a significant difference in preoperative LAVImin between symptomatic group and asymptomatic group (45.1±11.6 ml/m2 versus 27.1±9.2 ml/m2, P<0.01). ROC curve analysis revealed that the area under the curve was the largest (0.84, sensitivity 94.1% and specificity 69.6%) when preoperative LAVImin ≥30.3 ml/m2. In the multiple Logistic regression analysis, preoperative LAVImin was the independent predictor of the postoperative symptoms of AS (OR 2.17,95% CI 1.04-2.96, P=0.02). Conclusions The preoperative echocardiographic LAVImin could act as a predictive index for postoperative symptoms after SAVR in patients with AS. Preoperative LAVImin ≥30.3 ml/m2 is helpful for the choice of timing for SAVR in severe AS.