重度主动脉瓣狭窄患者瓣膜钙化程度对二尖瓣环形态的影响  

The Association Between the Extent of Aortic Valvular Calcification and Mitral Annular Geometry in Patients With Severe Aortic Stenosis

作　　者：孟庆龙 段福建[2] 万琳媛[1] 陈远 王浩[1] MENG Qinglong;DUAN Fujian;WAN Linyuan;CHEN Yuan;WANG Hao(Ultrasound Imaging Center,National Center for Cardiovascular Diseases and Fuwai Hospital,CAMS and PUMC,Beijing(100037),China)

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外医院超声影像中心,北京市100037 [2]中国医学科学院北京协和医学院国家心血管病中心阜外医院麻醉中心,北京市100037 [3]中国医学科学院北京协和医学院国家心血管病中心阜外医院放射影像科,北京市100037

出　　处：《中国循环杂志》2022年第11期1116-1122,共7页Chinese Circulation Journal

基　　金：首都临床特色应用研究与成果推广(Z161100000516097)。

摘　　要：目的:探讨重度主动脉瓣狭窄患者瓣膜钙化程度对二尖瓣环形态的影响。方法:纳入2018年8月至2020年12月期间我院因重度主动脉瓣狭窄拟行主动脉瓣置换术的患者50例(狭窄组),同时选取50例瓣膜正常者作为对照(对照组),均进行经食道三维超声心动图检查并获得二尖瓣环形态指标,比较狭窄组与对照组的二尖瓣环形态参数差异。狭窄组患者均进行CT扫描并获得主动脉瓣钙化积分,分析钙化积分与二尖瓣环形态指标间的相关性。结果:狭窄组患者男性35例(70.0%),平均年龄(61.44±11.98)岁;对照组男性32例(64.0%),平均年龄(58.26±6.43)岁,两组临床基线资料年龄、男性比例、身高、体重、血压和心率之间差异均无统计学意义(P均>0.05)。与对照组相比,狭窄组患者的二尖瓣环前后径、椭圆率、面积、周长、高度及非平面夹角均增大(P均<0.05)。狭窄组患者的平均主动脉瓣钙化积分为2365(1806,4440)AU,通过相关性分析发现,狭窄组的主动脉瓣钙化积分与主动脉瓣峰值流速(r=0.673)、峰值压差(r=0.677)、平均压差(r=0.649)均呈正相关,与主动脉瓣有效瓣口面积(r=-0.690)呈负相关(P均<0.05)。而主动脉瓣钙化积分与二尖瓣环的前后径(r=0.531)、面积(r=0.535)、周长(r=0.537)及高度(r=0.442)均呈正相关(P均<0.05)。结论:重度主动脉瓣狭窄患者存在二尖瓣环形态的改变,其主动脉瓣钙化程度越严重,二尖瓣环的形态变化则越明显。Objectives:To observe the association between the extent of aortic valvular calcification and mitral annular geometry in patients with severe aortic stenosis(AS).Methods:Fifty patients with calcific severe AS were enrolled in this study.The geometry parameters of the mitral annulus were obtained by three-dimensional transesophageal echocardiography.At the same time,fifty normal subjects were selected as the control group.The differences in mitral annular parameters were compared between the two groups.All patients in AS group underwent CT scan and aortic valve calcium scores was obtained.The relationship between mitral annular geometry parameters and calcium score was explored.Results:The mean age of patients with severe aortic stenosis was(61.44±11.98)years old(70.0%men)and the mean age of controls was(58.26±6.43)years old(64.0%men).There was no significant difference in baseline characteristics,including age,sex,height,weight,blood pressure and heart rate,between the two groups(all P>0.05).Compared to control group,the anteroposterior diameter,sphericity index,area,circumference,height,and the nonplanarity angle of mitral annulus were significantly larger in AS group(all P<0.05).The mean aortic valve calcium score of patients with severe aortic stenosis was 2365(1806,4440)AU.There was a positive correlation between aortic valve calcium score and the aortic valve peak velocity(r=0.673),the peak transvalvular pressure(r=0.677),and the mean transvalvular pressure(r=0.649),whereas there was a negative correlation between aortic valve calcium score and the effective aortic valve orifice area(r=-0.690,all P<0.05).There was a positive correlation between aortic valve calcium score and the anteroposterior diameter(r=0.531),area(r=0.535),circumference(r=0.537),and height(r=0.442)of mitral valve(all P<0.05).Conclusions:Mitral annular geometry changes were observed in calcific severe AS patients.The degree of aortic valve calcification is positively correlated with the changes in mitral annular geometry in these patient

关 键 词：主动脉瓣膜钙化 重度主动脉瓣狭窄 二尖瓣环形态 经食道三维超声心动图 

分 类 号：R54[医药卫生—心血管疾病]