超声心动图在二叶式主动脉瓣患者随访和预后分析中的应用价值  

Application value of echocardiography in the follow-up and prognostic analysis of patients with bicuspid aortic valve

作　　者：吴婷婷 潘昊天 赵锟 孙伟[1] 雍永宏 周蕾 周滨 孔祥清 WU Tingting;PAN Haotian;ZHAO Kun;SUN Wei;YONG Yonghong;ZHOU Lei;ZHOU Bin;KONG Xiangqing(Department of Cardiology,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院江苏省人民医院心血管内科,南京市210029

出　　处：《临床超声医学杂志》2023年第4期265-270,共6页Journal of Clinical Ultrasound in Medicine

基　　金：江苏省自然科学基金项目(BK20220711)。

摘　　要：目的探讨超声心动图在二叶式主动脉瓣(BAV)患者随访和预后分析中的应用价值。方法回顾性分析2013年1月1日至2019年12月31日我院经超声心动图诊断为BAV患者,比较不同随访时长患者的占比。收集有完整复查、随访资料的BAV患者,比较其初诊和末次复诊时的临床资料及超声心动图参数,包括左右房室内径、室壁厚度、瓣膜狭窄和反流程度、升主动脉内径、左室收缩功能参数、瓣膜形态学分型、多普勒血流参数。采用多因素Cox回归分析影响BAV预后的危险因素;绘制受试者工作特征曲线分析各因素预测BAV结局事件发生的效能;采用Kaplan-Meier法进行生存分析并绘制生存曲线和风险曲线。结果期间我院超声心动图共诊断BAV 1154例,最终纳入本研究者243例(21.06%),随访时间1年以内、1~2年、>2~3年、>3~4年、>4~5年及5年以上者分别有109例(44.86%)、38例(15.64%)、35例(14.40%)、20例(8.23%)、22例(9.05%)、19例(7.82%)。初诊与末次复诊时主动脉瓣狭窄程度、主动脉瓣反流程度及升主动脉内径比较,差异均有统计学意义(均P<0.01)。初诊时年龄、初诊时主动脉瓣狭窄程度、初诊时主动脉瓣反流程度为BAV结局事件发生的相关危险因素;且年龄为影响BAV预后的独立危险因素,其截断值为36岁,预测是否发生结局事件的灵敏度为94.29%,特异度为39.49%,曲线下面积为0.712。年龄≤36岁患者5年内不发生结局事件的概率为92.39%,年龄>36岁患者5年内不发生结局事件的概率仅52.20%。结论BAV人群随访率低,其引起的瓣膜功能障碍和升主动脉增宽具有时间累积效应。尤其对36岁以上BAV患者,应加强宣传教育,并建议每年连续随访超声心动图以指导治疗。Objective To investigate the application value of echocardiography in the follow-up and prognostic analysis of patients with bicuspid aortic valve(BAV).Methods A retrospective analysis was performed on patients diagnosed as BAV by echocardiography in our hospital from January 1,2013 to December 31,2019,and the proportion of patients with different follow-up duration was compared.BAV patients with complete reexamination and follow-up data were included in this study,and the clinical data and echocardiographic parameters at the first and last visit were compared,including diameter of atrium and ventriculum,ventricular wall thickness,degree of valvular stenosis and regurgitation,left ventricular systolic function parameters,ascending aorta diameter,morphological type of aortic valve,Doppler flow parameters.Multivariate Cox regression analysis was used to analyze the risk factors affecting the prognosis of BAV.Receiver operation characteristic curve was drawn to analyze the efficiency of each factor in predicting the occurrence of outcome events.Kaplan-Meier method was used for survival analysis and survival curve and risk curve were plotted.Results A total of 1154 cases of BAV were diagnosed by echocardiography in our hospital during the period,and 243 cases(21.06%)were eventually included in this study.There were 109 cases(44.86%),38 cases(15.64%),35 cases(14.40%),20 cases(8.23%),22 cases(9.05%)and 19 cases(7.82%)with follow-up time within 1 year,1~2 years,>2~3 years,>3~4 years,>4~5 years and more than 5 years,respectively.There were significant differences in the degree of aortic stenosis and regurgitation,ascending aorta diameter between the first and the last visit(all P<0.01).Age,the degree of aortic stenosis and regurgitation at initial diagnosis were the risk factors for the occurence of BAV outcome event.Age was an independent risk factor for BAV prognosis,with a cutoff value of 36 years old,and the sensitivity and specificity for predicting the occurence of outcome event were 94.29%and 39.49%,respectively,t

关 键 词：超声心动描记术 二叶式主动脉瓣 随访 预后分析 

分 类 号：R540.45[医药卫生—心血管疾病]