低梯度主动脉瓣狭窄的多巴酚丁胺应激超声心动图检查

IF 5.4 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Journal of the American Society of Echocardiography Pub Date : 2024-11-01 DOI:10.1016/j.echo.2024.06.017
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引用次数: 0

摘要

重要性:指南建议在低梯度主动脉瓣狭窄(AS)和左室射血分数(LVEF)为35%的患者中使用多巴酚丁胺应激超声心动图(DSE):研究低梯度主动脉瓣狭窄(AS)且左心室射血分数(LVEF)范围较宽的患者的 DSE 诊断准确性,并研究 DSE 诊断准确性与 LVEF 之间的相互作用:从三个前瞻性收集的患者队列中识别出平均梯度2、卒中容积指数≤35 mL/m2、接受DSE和心脏计算机断层扫描(C-CT)的患者,并根据LVEF进行分层;LVEF50%:主要结果和测量指标:重度强直性脊柱炎的定义是:C-CT上男性的AVC评分≥2000 AU,女性的AVC评分≥1200 AU:在纳入研究的 221 名患者中,78 人(35%)的 LVEF 为 50%。DSE 期间的平均梯度和 Vmax 在 LVEF 组间显示出明显的诊断异质性,在 LVEFC 时最为精确:虽然 DSE 是安全的,而且无论 LVEF 如何,都能增加低梯度 AS 患者的搏出量,但 DSE 梯度与 C-CT 评估的 AS 严重程度之间的关联显示出重要的异质性,这取决于 LVEF,其中 LVEF 为 50% 的患者的诊断准确性最高。
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Dobutamine Stress Echocardiography in Low-Gradient Aortic Stenosis

Importance

Guidelines recommend the use of dobutamine stress echocardiography (DSE) in patients with low-gradient aortic stenosis (AS) and left ventricular ejection fraction (LVEF) <50%. However, a paucity of DSE data exists when LVEF >35%.

Objective

To examine the diagnostic accuracy of DSE in patients with low-gradient AS with a wide range of LVEF and to examine the interaction between the diagnostic accuracy of DSE and LVEF.

Design, Setting, and Participants

Patients with mean gradient <40 mm Hg, aortic valve area <1.0 cm2, and stroke volume index ≤35 mL/m2 undergoing DSE and cardiac computer tomography (C-CT) were identified from 3 prospectively collected patient cohorts and stratified according to LVEF: LVEF<35%, LVEF 35% to 50%, and LVEF>50%.

Exposure

Dobutamine stress echocardiography and C-CT were performed on patients with low-gradient AS.

Main Outcomes and Measures

Severe AS was defined as aortic valve calcification score ≥2,000 arbitrary units (AU) among men and ≥1,200 AU for women on C-CT.

Results

Of 221 patients included in the study, 78 (35%) presented with LVEF <35%, 67 (30%) with LVEF 35% to 50%, and 76 (34%) with LVEF >50%. Mean-gradient and aortic valve peak velocity during DSE showed significant diagnostic heterogeneity between LVEF groups, being most precise when LVEF <35% (both areas under the curve [AUC] = 0.90), albeit with optimal thresholds of 30 mm Hg and 377 cm/sec and a limited diagnostic yield in patients with LVEF ≥35% (AUC = 0.67 and 0.66 in LVEF 35% to 50% and AUC = 0.65 and 0.60 in LVEF ≥50%). Using guideline thresholds led to a sensitivity/specificity of 49%/84% for all patients with LVEF <50%.

Conclusion and Relevance

While DSE is safe and leads to an increase in stroke volume in patients with low-gradient AS regardless of LVEF, the association between DSE gradients and AS severity assessed by C-CT demonstrates important heterogeneity depending on LVEF, with the highest accuracy in patients with LVEF <35%.
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来源期刊
CiteScore
9.50
自引率
12.30%
发文量
257
审稿时长
66 days
期刊介绍: The Journal of the American Society of Echocardiography(JASE) brings physicians and sonographers peer-reviewed original investigations and state-of-the-art review articles that cover conventional clinical applications of cardiovascular ultrasound, as well as newer techniques with emerging clinical applications. These include three-dimensional echocardiography, strain and strain rate methods for evaluating cardiac mechanics and interventional applications.
期刊最新文献
Application of Machine Learning Technology to Automate Thoracic Aorta Dimensions by Echocardiography. Association with Outcomes of Correcting the PISA Method to Quantitate Secondary Tricuspid Regurgitation. Dobutamine in low-flow, low-gradient severe aortic stenosis with preserved ejection fraction: Is exercise testing the key? - Authors' reply. Table of Contents Editorial Board
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