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Сопоставимость диагностических возможностей отношения времени ускорения к общему времени выброса левого желудочка (AT/ET) в определении тяжести аортального стеноза у пациентов с дву- и трёхстворчатым строением аортального клапана
Сопоставимость диагностических возможностей отношения времени ускорения к общему времени выброса левого желудочка (AT/ET) в определении тяжести аортального стеноза у пациентов с дву- и трёхстворчатым строением аортального клапана
Базылев В.В., Бабуков Р.М., Бартош Ф.Л., Лёвина А.В., Микуляк А.И. Сопоставимость диагностических возможностей отношения времени ускорения к общему времени выброса левого желудочка (AT/ET) в определении тяжести аортального стеноза у пациентов с дву- и трёхстворчатым строением аортального клапана: ретроспективное сравнительное исследование. CardioСоматика. 2022. Т. 13, № 4. С. 192–197. DOI: https://doi.org/10.17816/CS108733
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Аннотация
Цель. Сравнить сопоставимость диагностических возможностей соотношения времени ускорения к общему времени выброса левого желудочка (AT/ET) в определении тяжести аортального стеноза (АС) у пациентов с дву- и трёхстворчатым строением аортального клапана (АК).
Материал и методы. Ретроспективно проанализированы данные 187 пациентов с умеренным и тяжёлым АС, которые проходили диагностическое обследование в ФЦССХ (Пенза). Пациенты были разделены на 2 группы в зависимости от строения (трёх- или и двустворчатого) АК. Визуальную оценку строения АК проводили с помощью трансторакальной эхокардиографии, в неопределённых случаях применяли компьютерную томографию.
Результаты. Сравнительный анализ эхокардиографических характеристик групп пациентов с трёх- и двустворчатым строением АК не продемонстрировал статистически значимой разницы у пациентов как с тяжёлым, так и с умеренным стенозом АК (p ≤0,05). Анализ линейной регрессии у пациентов с трёхстворчатым АК показал статистически значимую корреляционную связь между показателями АT/ET и Gmax (r=0,68, р=0,03), Gmean (r=0,78, р=0,01), EOA (r=0,7, р=0,03) и DVI (r=0,72, р=0,02). Аналогичная значимая корреляционная связь была обнаружена и у пациентов с двустворчатым строением АК между показателя АT/ET и Gmax (r=0,67, р=0,02), Gmean (r=0,8, р <0,001), EOA (r=0,72, р=0,04) и DVI (r=0,75, р=0,01). Кривая RОC-анализа продемонстрировала высокую предсказательную способность тяжёлого стеноза АК показателем АT/ET (при значении >0,35) как у пациентов с трёх-, так и с двустворчатым строением АК: площади под кривой AUC=84 (p <0,001) и АUC=0,86 (p <0,001) соответственно. Чувствительность и специфичность показателя AT/ET >0,35 в определении тяжёлого стеноза АК у пациентов с трёхстворчатым АК составили 84 и 75% соответственно, у пациентов с двустворчатым строением АК – 87 и 78% соответственно.
Заключение. Отношение AT/ET обладает сопоставимыми диагностическими возможностями в определении тяжёлого АС как у пациентом с трёх-, так и с двустворчатым строением АК. Пороговое значение AT/ET >0,35 является высокочувствительным параметром для определения тяжёлого АС для обеих морфологий АК.
Ключевые слова: аортальный стеноз, двустворчатый аортальный клапан, трехстворчатый аортальный клапан, соотношение AT/ET
Material and methods. We retrospectively analyzed the data of 187 patients with moderate and severe AS who underwent diagnostic examination at the Penza Federal Center for Cardiovascular Surgery. The patients were divided into 2 groups based on whether their AV was tricuspid or bicuspid. Visual assessment of the AV structure was performed using transthoracic echocardiography (TTE). In indeterminate cases, computed tomography was used for the assessment.
Results. A comparative analysis of the echocardiographic characteristics of patients with tricuspid and bicuspid AV did not reveal a statistically significant difference between the patient groups (p ≤0.05). Linear regression analysis in patients with a tricuspid AV demonstrated a statistically significant correlation between AT/ET scores and peak gradient (Gmax) (r=0.68, р=0.03), mean gradient (Gmean) (r=0.78, р=0.01), effective orifice area (EOA) (r=0.7, р=0.03), and doppler velocity index (DVI) scores (r=0.72, р=0.02). In patients with a bicuspid AV, a similarly significant correlation was found between the AT/ET index and Gmax (r=0.67, р=0.02), Gmean (r=0.8, р <0.001), EOA (r=0.72, р=0.04), and DVI (r=0.75, р=0.01). The receiver operating characteristic analysis demonstrated a high predictive ability of AT/ET for severe aortic valve stenosis (with a value >0.35). The area under the curve in patients with tricuspid and bicuspid AV was 84 (p <0.001) and 86 (p <0.001), respectively. For determining severe AV stenosis in patients with a tricuspid AV, the sensitivity and specificity of AT/ET >0.35 was 84% and 75%, respectively; and in patients with a bicuspid AV, it was 87% and 78%, respectively.
Conclusion. The AT/ET ratio has comparable diagnostic capabilities in determining severe AS in patients with tricuspid and bicuspid AV structures. The AT/ET >0.35 is a highly sensitive parameter for defining severe AS for both morphologies of AV.
Keywords: aortic stenosis, bicuspid aortic valve, AT/ET ratio
Материал и методы. Ретроспективно проанализированы данные 187 пациентов с умеренным и тяжёлым АС, которые проходили диагностическое обследование в ФЦССХ (Пенза). Пациенты были разделены на 2 группы в зависимости от строения (трёх- или и двустворчатого) АК. Визуальную оценку строения АК проводили с помощью трансторакальной эхокардиографии, в неопределённых случаях применяли компьютерную томографию.
Результаты. Сравнительный анализ эхокардиографических характеристик групп пациентов с трёх- и двустворчатым строением АК не продемонстрировал статистически значимой разницы у пациентов как с тяжёлым, так и с умеренным стенозом АК (p ≤0,05). Анализ линейной регрессии у пациентов с трёхстворчатым АК показал статистически значимую корреляционную связь между показателями АT/ET и Gmax (r=0,68, р=0,03), Gmean (r=0,78, р=0,01), EOA (r=0,7, р=0,03) и DVI (r=0,72, р=0,02). Аналогичная значимая корреляционная связь была обнаружена и у пациентов с двустворчатым строением АК между показателя АT/ET и Gmax (r=0,67, р=0,02), Gmean (r=0,8, р <0,001), EOA (r=0,72, р=0,04) и DVI (r=0,75, р=0,01). Кривая RОC-анализа продемонстрировала высокую предсказательную способность тяжёлого стеноза АК показателем АT/ET (при значении >0,35) как у пациентов с трёх-, так и с двустворчатым строением АК: площади под кривой AUC=84 (p <0,001) и АUC=0,86 (p <0,001) соответственно. Чувствительность и специфичность показателя AT/ET >0,35 в определении тяжёлого стеноза АК у пациентов с трёхстворчатым АК составили 84 и 75% соответственно, у пациентов с двустворчатым строением АК – 87 и 78% соответственно.
Заключение. Отношение AT/ET обладает сопоставимыми диагностическими возможностями в определении тяжёлого АС как у пациентом с трёх-, так и с двустворчатым строением АК. Пороговое значение AT/ET >0,35 является высокочувствительным параметром для определения тяжёлого АС для обеих морфологий АК.
Ключевые слова: аортальный стеноз, двустворчатый аортальный клапан, трехстворчатый аортальный клапан, соотношение AT/ET
________________________________________________
Material and methods. We retrospectively analyzed the data of 187 patients with moderate and severe AS who underwent diagnostic examination at the Penza Federal Center for Cardiovascular Surgery. The patients were divided into 2 groups based on whether their AV was tricuspid or bicuspid. Visual assessment of the AV structure was performed using transthoracic echocardiography (TTE). In indeterminate cases, computed tomography was used for the assessment.
Results. A comparative analysis of the echocardiographic characteristics of patients with tricuspid and bicuspid AV did not reveal a statistically significant difference between the patient groups (p ≤0.05). Linear regression analysis in patients with a tricuspid AV demonstrated a statistically significant correlation between AT/ET scores and peak gradient (Gmax) (r=0.68, р=0.03), mean gradient (Gmean) (r=0.78, р=0.01), effective orifice area (EOA) (r=0.7, р=0.03), and doppler velocity index (DVI) scores (r=0.72, р=0.02). In patients with a bicuspid AV, a similarly significant correlation was found between the AT/ET index and Gmax (r=0.67, р=0.02), Gmean (r=0.8, р <0.001), EOA (r=0.72, р=0.04), and DVI (r=0.75, р=0.01). The receiver operating characteristic analysis demonstrated a high predictive ability of AT/ET for severe aortic valve stenosis (with a value >0.35). The area under the curve in patients with tricuspid and bicuspid AV was 84 (p <0.001) and 86 (p <0.001), respectively. For determining severe AV stenosis in patients with a tricuspid AV, the sensitivity and specificity of AT/ET >0.35 was 84% and 75%, respectively; and in patients with a bicuspid AV, it was 87% and 78%, respectively.
Conclusion. The AT/ET ratio has comparable diagnostic capabilities in determining severe AS in patients with tricuspid and bicuspid AV structures. The AT/ET >0.35 is a highly sensitive parameter for defining severe AS for both morphologies of AV.
Keywords: aortic stenosis, bicuspid aortic valve, AT/ET ratio
Полный текст
Список литературы
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2. Minners J, Allgeier M, Gohlke-Baerwolf C, et al. Inconsistent grading of aortic valve stenosis by current guidelines: haemodynamic studies in patients with apparently normal left ventricular function. Heart. 2010;96(18):1463–1468. doi: 10.1136/hrt.2009.181982
3. Belkin RN, Khalique O, Aronow WS, et al. Outcomes and survival with aortic valve replacement compared with medical therapy in patients with low-, moderate-, and severe-gradient severe aortic stenosis and normal left ventricular ejection fraction. Echocardiography. 2011;28(4):378–387. doi: 10.1111/j.1540-8175.2010.01372.x
4. Clavel MA, Messika-Zeitoun D, Pibarot P, et al. The complex nature of discordant severe calcified aortic valve disease grading: new insights from combined Doppler echocardiographic and computed tomographic study. J Am Coll Cardiol. 2013;62(24):2329–2338. doi: 10.1016/j.jacc.2013.08.1621
5. Zoghbi WA, Chambers JB, Dumesnil JG, et al. Recommendations for evaluation of prosthetic valves with echocardiography and doppler ultrasound: a report From the American Society of Echocardiography's Guidelines and Standards Committee and the Task Force on Prosthetic Valves, developed in conjunction with the American College of Cardiology Cardiovascular Imaging Committee, Cardiac Imaging Committee of the American Heart Association, the European Association of Echocardiography, a registered branch of the European Society of Cardiology, the Japanese Society of Echocardiography and the Canadian Society of Echocardiography, endorsed by the American College of Cardiology Foundation, American Heart Association, European Association of Echocardiography, a registered branch of the European Society of Cardiology, the Japanese Society of Echocardiography, and Canadian Society of Echocardiography. J Am Soc Echocardiogr. 2009;22(9):975–1014;quiz 1082–1084. doi: 10.1016/j.echo.2009.07.013
6. Ben Zekry S, Saad RM, Ozkan M, et al. Flow acceleration time and ratio of acceleration time to ejection time for prosthetic aortic valve function. JACC Cardiovasc Imaging. 2011;4(11):1161–1170. doi: 10.1016/j.jcmg.2011.08.012
7. Gamaza-Chulián S, Camacho-Freire S, Toro-Cebada R, et al. Ratio of Acceleration Time to Ejection Time for Assessing Aortic Stenosis Severity. Echocardiography. 2015;32(12):1754–1761. doi: 10.1111/echo.12978
8. Kamimura D, Hans S, Suzuki T, et al. Delayed Time to Peak Velocity Is Useful for Detecting Severe Aortic Stenosis. J Am Heart Assoc. 2016;5(10):e003907. doi: 10.1161/JAHA.116.003907
9. Ringle Griguer A, Tribouilloy C, Truffier A, et al. Clinical Significance of Ejection Dynamics Parameters in Patients with Aortic Stenosis: An Outcome Study. J Am Soc Echocardiogr. 2018;31(5):551–560.e2. doi: 10.1016/j.echo.2017.11.015
10. Gamaza-Chulián S, Díaz-Retamino E, Camacho-Freire S, et al. Acceleration Time and Ratio of Acceleration Time to Ejection Time in Aortic Stenosis: New Echocardiographic Diagnostic Parameters. J Am Soc Echocardiogr. 2017;30(10):947–955. doi: 10.1016/j.echo.2017.06.001
11. Bazylev VV, Babukov RM, Bartosh FL, Gorshkova AV. Comparison of the hemodynamic parameters of transaortic blood flow in patients with aortic stenosis depending on the bicuspid or tricuspid valve structure. Medical Visualization. 2020;24(4):74–80. (In Russ). doi: 10.24835/1607-0763-2020-4-74-80
12. Huntley GD, Thaden JJ, Alsidawi S, et al. Comparative study of bicuspid vs. tricuspid aortic valve stenosis. Eur Heart J Cardiovasc Imaging. 2018;19(1):3–8. doi: 10.1093/ehjci/jex211
13. Richards KE, Deserranno D, Donal E, et al. Influence of structural geometry on the severity of bicuspid aortic stenosis. Am J Physiol Heart Circ Physiol. 2004;287(3):H1410–H1416. doi: 10.1152/ajpheart.00264.2003
14. Baumgartner H Chair, Hung J Co-Chair, Bermejo J, et al. Recommendations on the echocardiographic assessment of aortic valve stenosis: a focused update from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. Eur Heart J Cardiovasc Imaging. 2017;18(3):254–275. doi: 10.1093/ehjci/jew335
15. McSweeney J, Dobson L, Macnab A. Acceleration time and ratio of acceleration time and ejection time in bicuspid aortic stenosis; a valid clinical measure? Heart. 2020;106(Suppl 2):A1–A118. doi: 10.1136/heartjnl-2020-BCS.8
2. Minners J., Allgeier M., Gohlke-Baerwolf C., et al. Inconsistent grading of aortic valve stenosis by current guidelines: haemodynamic studies in patients with apparently normal left ventricular function // Heart. 2010. Vol. 96, N 18. P. 1463–1468. doi: 10.1136/hrt.2009.181982
3. Belkin R.N., Khalique O., Aronow W.S., et al. Outcomes and survival with aortic valve replacement compared with medical therapy in patients with low-, moderate-, and severe-gradient severe aortic stenosis and normal left ventricular ejection fraction // Echocardiography. 2011. Vol. 28, N 4. P. 378–387. doi: 10.1111/j.1540-8175.2010.01372.x
4. Clavel M.A., Messika-Zeitoun D., Pibarot P., et al. The complex nature of discordant severe calcified aortic valve disease grading: new insights from combined Doppler echocardiographic and computed tomographic study // J Am Coll Cardiol. 2013. Vol. 62, N 24. P. 2329–2338. doi: 10.1016/j.jacc.2013.08.1621
5. Zoghbi W.A., Chambers J.B., Dumesnil J.G., et al. Recommendations for evaluation of prosthetic valves with echocardiography and doppler ultrasound: a report From the American Society of Echocardiography's Guidelines and Standards Committee and the Task Force on Prosthetic Valves, developed in conjunction with the American College of Cardiology Cardiovascular Imaging Committee, Cardiac Imaging Committee of the American Heart Association, the European Association of Echocardiography, a registered branch of the European Society of Cardiology, the Japanese Society of Echocardiography and the Canadian Society of Echocardiography, endorsed by the American College of Cardiology Foundation, American Heart Association, European Association of Echocardiography, a registered branch of the European Society of Cardiology, the Japanese Society of Echocardiography, and Canadian Society of Echocardiography // J Am Soc Echocardiogr. 2009. Vol. 22, N 9. P. 975–1014. Quiz. 1082–1084. doi: 10.1016/j.echo.2009.07.013
6. Ben Zekry S., Saad R.M., Ozkan M., et al. Flow acceleration time and ratio of acceleration time to ejection time for prosthetic aortic valve function // JACC Cardiovasc Imaging. 2011. Vol. 4, N 11. P. 1161–1170. doi: 10.1016/j.jcmg.2011.08.012
7. Gamaza-Chulián S., Camacho-Freire S., Toro-Cebada R., et al. Ratio of Acceleration Time to Ejection Time for Assessing Aortic Stenosis Severity // Echocardiography. 2015. Vol. 32, N 12. P. 1754–1761. doi: 10.1111/echo.12978
8. Kamimura D., Hans S., Suzuki T., et al. Delayed Time to Peak Velocity Is Useful for Detecting Severe Aortic Stenosis // J Am Heart Assoc. 2016. Vol. 5, N 10. P. e003907. doi: 10.1161/JAHA.116.003907
9. Ringle Griguer A., Tribouilloy C., Truffier A., et al. Clinical Significance of Ejection Dynamics Parameters in Patients with Aortic Stenosis: An Outcome Study // J Am Soc Echocardiogr. 2018. Vol. 31, N 5. P. 551.e2–560.e2. doi: 10.1016/j.echo.2017.11.015
10. Gamaza-Chulián S., Díaz-Retamino E., Camacho-Freire S., et al. Acceleration Time and Ratio of Acceleration Time to Ejection Time in Aortic Stenosis: New Echocardiographic Diagnostic Parameters // J Am Soc Echocardiogr. 2017. Vol. 30, N 10. P. 947–955. doi: 10.1016/j.echo.2017.06.001
11. Базылев В.В., Бабуков Р.М., Бартош Ф.Л., Горшкова А.В. Сравнение гемодинамических параметров трансаортального кровотока у пациентов с аортальным стенозом в зависимости от двустворчатого или трехстворчатого строения клапана // Медицинская визуализация. 2020. Т. 24, № 4. С. 74–80. doi: 10.24835/1607-0763-2020-4-74-80
12. Huntley G.D., Thaden J.J., Alsidawi S., et al. Comparative study of bicuspid vs. tricuspid aortic valve stenosis // Eur Heart J Cardiovasc Imaging. 2018. Vol. 19, N 1. P. 3–8. doi: 10.1093/ehjci/jex211
13. Richards K.E., Deserranno D., Donal E., et al. Influence of structural geometry on the severity of bicuspid aortic stenosis // Am J Physiol Heart Circ Physiol. 2004. Vol. 287, N 3. P. H1410–H1416. doi: 10.1152/ajpheart.00264.2003
14. Baumgartner H. Chair, Hung J. Co-Chair, Bermejo J., et al. Recommendations on the echocardiographic assessment of aortic valve stenosis: a focused update from the European Association of Cardiovascular Imaging and the American Society of Echocardiography // Eur Heart J Cardiovasc Imaging. 2017. Vol. 18, N 3. P. 254–275. doi: 10.1093/ehjci/jew335
15. McSweeney J., Dobson L., Macnab A. Acceleration time and ratio of acceleration time and ejection time in bicuspid aortic stenosis; a valid clinical measure? // Heart. 2020. Vol. 106, Suppl. 2. P. A1–A118. doi: 10.1136/heartjnl-2020-BCS.
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2. Minners J, Allgeier M, Gohlke-Baerwolf C, et al. Inconsistent grading of aortic valve stenosis by current guidelines: haemodynamic studies in patients with apparently normal left ventricular function. Heart. 2010;96(18):1463–1468. doi: 10.1136/hrt.2009.181982
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Авторы
В.В. Базылев, Р.М. Бабуков*, Ф.Л. Бартош, А.В. Лёвина, А.И. Микуляк
ФГБУ «Федеральный центр сердечно-сосудистой хирургии» Минздрава России, Пенза, Россия
*ruslan.babukov@mail.ru
Federal Centre for Cardiovascular Surgery, Penza, Russia
*ruslan.babukov@mail.ru
ФГБУ «Федеральный центр сердечно-сосудистой хирургии» Минздрава России, Пенза, Россия
*ruslan.babukov@mail.ru
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Federal Centre for Cardiovascular Surgery, Penza, Russia
*ruslan.babukov@mail.ru
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