不同严重程度主动脉瓣狭窄患者超声心动图参数进展的研究  

Progress of echocardiographic parameters in patients with different severity of aortic stenosis

作　　者：马佳 张丽伟[1] 马永江[1] 郭马特 孙诗敏 张梅青[2] 王秋霜[2] 宋艳杰 石婵 杨菲菲[1] Ma Jia;Zhang Liwei;Ma Yongjiang;Guo Mate;Sun Shimin;Zhang Meiqing;Wang Qiushuang;Song Yanjie;Shi Chan;Yang Feifei(Department of Cardiology,Sixth Medical Center of Chinese PLA General Hospital,Beijing 100037,China)

机构地区：[1]解放军总医院第六医学中心心血管病学部,北京100037 [2]解放军总医院第四医学中心健康医学科 [3]解放军总医院第四医学中心心血管内科

出　　处：《中华老年心脑血管病杂志》2024年第11期1253-1257,共5页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：国家自然科学基金(82202265)。

摘　　要：目的 探讨在不同严重程度主动脉瓣狭窄患者中二维超声心动图参数进展情况。方法 回顾性分析2017年3月至2023年12月解放军总医院第四医学中心心血管内科门诊就诊的主动脉瓣狭窄且至少有2次经胸超声心动图(间隔≥1年)患者96例,根据主动脉瓣狭窄程度分为轻度狭窄组72例,中度狭窄组14例和重度狭窄组10例,所有患者经胸超声心动图检查,测量主动脉瓣最大跨瓣压差、主动脉瓣峰值流速(peak transvalvular velocity, Vmax)、主动脉瓣平均跨膜压差、肺动脉收缩压等参数,分析基线及随访前后超声心动图参数变化及年进展率。结果 轻、中、重度狭窄组室间隔厚度、左心室后壁厚度、Vmax、主动脉瓣最大跨瓣压差、主动脉瓣平均跨膜压差明显逐渐升高(P<0.05,P<0.01)。轻度狭窄组Vmax、主动脉瓣最大跨瓣压差、主动脉瓣平均跨膜压差明显低于中、重度狭窄组,左心室后壁厚度明显低于重度狭窄组(P<0.05)。轻、中、重度狭窄组随访后主动脉瓣最大跨瓣压差、主动脉瓣平均跨膜压差明显高于随访前(P<0.05,P<0.01)。轻、中度狭窄组随访后Vmax明显高于随访前(P<0.01);重度狭窄组随访后肺动脉收缩压明显高于随访前(P<0.05)。轻、中、重度狭窄组Vmax年进展率、肺动脉收缩压年进展率、左心室射血分数年进展率绝对值逐渐升高,但差异无统计学意义(P>0.05),轻、中、重度狭窄组主动脉瓣平均跨膜压差年进展率明显逐渐升高[(2.30±1.77)mm Hg/y vs(2.40±1.18)mm Hg/y vs(6.08±1.70)mm Hg/y,P<0.05]。结论 随着基线主动脉瓣狭窄严重程度的增加,心脏结构及功能明显变化,随访前后,主动脉瓣狭窄程度越重,主动脉瓣峰值流速、主动脉瓣平均跨膜压差、左心室射血分数、肺动脉收缩压年进展率越快。Objective To investigate the progress of two-dimensional echocardiographic parameters in patients with different severity of aortic stenosis.Methods A retrospective analysis was performed on 96 patients diagnosed with aortic stenosis with at least 2 times of transthoracic echocardiography(interval≥1 year)in Department of Cardiology,Fourth Medical Center of Chinese PLA General Hospital from March 2017 to December 2023.According to aortic stenosis severity,they were divided into a mild group(72 cases),a moderate group(14 cases)and a severe group(10 cases).Peak pressure gradient(PPG)across aortic valve,Vmax,mean aortic valve pressure gradient(ΔPm),pulmonary artery systolic pressure(PASP)were collected,and the changes and annual progress of these echocardiographic parameters at baseline and before and after follow-up were analyzed.Results The values of IVST,LVPWT,Vmax,aortic valve PPG andΔPm were significantly increased in the mild,moderate and severe stenosis groups in turn(P<0.05,P<0.01).The values of Vmax,PPG andΔPm were significantly lower in the mild stenosis group than the moderate and severe stenosis groups,and the LVPWT value was obviously lower in the mild stenosis group than the severe stenosis group(P<0.05).The aortic valve PPG andΔPm values at follow-up were significantly higher than those before the follow-up in the three stenosis groups(P<0.05,P<0.01).After follow-up,the Vmax values in mild and moderate stenosis groups were notably higher than before(P<0.01).The PASP value at follow-up was significantly higher than before in the severe stenosis group(P<0.05).The annual progression rate of Vmax,PASP,LVEF were gradually increased in the mild,moderate,and severe stenosis groups(P>0.05).The annual progression rate ofΔPm was gradually increased in the three groups in turn(2.30±1.77 mm Hg/year vs 2.40±1.18 mm Hg/year vs 6.08±1.70 mm Hg/year,P<0.05).Conclusion As the severity of baseline aortic stenosis increases,obvious changes are observed in cardiac structure and function.Before and after follow-u

关 键 词：主动脉瓣狭窄 超声心动描记术 主动脉瓣最大跨瓣压差 主动脉瓣峰值流速 

分 类 号：R542.52[医药卫生—心血管疾病] R540.45[医药卫生—内科学]