左心房容积指数在无症状重度主动脉瓣狭窄患者中的临床应用

发布时间：2019-01-27 14:24

【摘要】：目的探讨左心房容积指数在诊断无症状重度主动脉瓣狭窄(AS)患者中的应用价值。方法收集左心室射血分数(LVEF)50%重度AS患者48例,根据有无临床症状分为有症状AS组及无症状AS组,每组各24例。采用超声心动图测量左心室腔大小及左心室质量(LVMI),通过Simpson法测得左心房容积指数,PWD测量二尖瓣舒张早期和晚期血流速度峰值(E、A),DTI测量二尖瓣环舒张早期及舒张晚期血流速度峰值(Em、Am)。根据重度AS患者临床症状鉴别标准构建ROC曲线。LAVI与超声参数的相关性采用Spearman和Pearson相关分析;对LAVI增大的其他主要影响因素进行多因素回归分析。结果有症状AS组较无症状AS组AV、MPG、PWT、SWT均增加(P均0.05);有症状AS组LAVI明显高于无症状AS组(P=0.001)。LAVI预测有症状重度AS患者的最佳界值为39.85ml/m2,曲线下面积0.959,敏感度95.5%,特异度68.2%;LAVI与E/Em、LVMI呈正相关(r=0.639、0.658,P均0.001)。多因素回归分析结果显示,E/Em和LVMI是LAVI的独立影响因子。结论 LAVI能预测无症状重度AS,且与左心室舒张功能指标有很好的相关性。
[Abstract]:Objective to evaluate the value of left atrial volume index in the diagnosis of asymptomatic severe aortic stenosis (AS). Methods 48 patients with (LVEF) 50% severe AS with left ventricular ejection fraction were divided into symptomatic AS group and asymptomatic AS group according to their clinical symptoms. Left atrial volume index (LVVI) was measured by left ventricular mass (LVMI),) and left ventricular lumen size (LVMI),) by echocardiography, and mitral valve diastolic peak (EMA) was measured by PWD, and the left atrial volume index (LVI) was measured by Simpson method. Early diastolic and late diastolic peak blood flow velocity (Em,Am) of mitral annulus was measured by DTI. The ROC curve was constructed according to the differential criteria of clinical symptoms in patients with severe AS. The correlation between LAVI and ultrasonic parameters was analyzed by Spearman and Pearson, and the other main influencing factors of LAVI increase were analyzed by multivariate regression analysis. Results the AV,MPG,PWT,SWT of symptomatic AS group was higher than that of asymptomatic AS group (P0. 05). The LAVI of the symptomatic AS group was significantly higher than that of the asymptomatic AS group (P0. 001). LAVI was used to predict the optimal threshold value of 39.85 ml / m ~ 2 for the patients with severe symptomatic AS, the area under the curve was 0.959, the sensitivity was 95.5 and the specificity was 68.2). There was a positive correlation between LAVI and E / E (r = 0.639, P = 0.658, P = 0.001). Multivariate regression analysis showed that E/Em and LVMI were independent factors of LAVI. Conclusion LAVI can predict asymptomatic severe AS, and has good correlation with left ventricular diastolic function.
【作者单位】：南昌大学第一附属医院超声诊断科;
【分类号】：R445.1;R542.5

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