Sergio Gamaza-Chulián, Fátima González-Testón, Enrique Díaz-Retamino, Francisco M Zafra-Cobo, Eva González-Caballero
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A receiver operating characteristic curve was plotted to determine the best cutoff value of EOA/height for predicting cardiovascular events.</p><p><strong>Results: </strong>Four-hundred and fifteen patients were included (52% women, mean age 74.8 ± 11.6 years). Area under the curve was similar for EOA/BSA (AUC 0.75, p < 0.001) and EOA/height (AUC 0.75, p < 0.001). A cutoff value of 0.60 cm<sup>2</sup>/m for EOA/height had a sensitivity of 84%, specificity of 61%, positive predictive value of 60% and negative predictive value of 84%. One-year survival from primary endpoint was significantly lower in patients with EOA/height ≤ 0.60 cm<sup>2</sup>/m (48 ± 5% vs 91 ± 4%, log-rank p < 0.001) than EOA/height > 0.60 cm<sup>2</sup>/m. The excess of risk of cardiovascular events seen in univariate analysis persists even after adjustment for other demonstrated adverse prognostic variables (HR 5.91, 95% CI 3.21-10.88, p < 0.001). In obese patients, there was an excess of risk in patients with EOA/height < 0.60 cm2/m (HR 10.2, 95% CI 3.5-29.5, p < 0.001), but not in EOA/BSA < 0.60 cm<sup>2</sup>/m<sup>2</sup> (HR 0.14, 95% CI 0.14-1.4, p = 0.23).</p><p><strong>Conclusions: </strong>We could identify a subgroup of patients with AS at high risk of cardiovascular events. 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引用次数: 0
摘要
背景:虽然推荐通过体表面积(BSA)索引有效孔口面积(EOA)，但这种方法有几个缺点，因为它是通过获得性脂肪组织进行校正的。我们的目的是分析经高度归一化的EOA对主动脉瓣狭窄(AS)患者心血管预后的预测价值。方法:前瞻性纳入2015年1月至2018年6月超声心动图实验室评估的AS(峰值流速> 2 m/s)患者。通过BSA和高度对EOA进行索引。复合主要终点定义为心源性死亡或主动脉瓣置换术。绘制受试者工作特征曲线，以确定预测心血管事件的最佳EOA/height截断值。结果:纳入415例患者(女性52%，平均年龄74.8±11.6岁)。曲线下面积与EOA/BSA相似(AUC为0.75)，p2 /m对EOA/高度的敏感性为84%，特异性为61%，阳性预测值为60%，阴性预测值为84%。EOA/身高≤0.60 cm2/m的患者从主要终点开始的一年生存率显著降低(48±5% vs 91±4%，log-rank p 0.60 cm2/m)。单因素分析中发现的心血管事件风险过高，即使在调整了其他已证实的不良预后变量后仍然存在(HR 5.91, 95% CI 3.21-10.88, p 2/m2) (HR 0.14, 95% CI 0.14-1.4, p = 0.23)。结论:我们可以确定一个心血管事件高风险的AS患者亚组。因此，我们建议使用EOA/身高作为as的指标，特别是在肥胖患者中，截断值为0.60 cm2/m，以确定心血管风险较高的患者。
An alternative method of indexation in aortic stenosis: height-adjusted effective orifice area : An observational prospective study.
Background: Although indexing effective orifice area (EOA) by body surface area (BSA) is recommended, this method has several disadvantages, since it corrects by acquired fatty tissue. Our aim was to analyze the value of EOA normalized by height for predicting cardiovascular outcome in patients with aortic stenosis (AS).
Methods: Patients with AS (peak velocity > 2 m/s) evaluated in our echocardiography laboratory between January 2015 and June 2018 were prospectively enrolled. EOA was indexed by BSA and height. A composite primary endpoint was defined as cardiac death or aortic valve replacement. A receiver operating characteristic curve was plotted to determine the best cutoff value of EOA/height for predicting cardiovascular events.
Results: Four-hundred and fifteen patients were included (52% women, mean age 74.8 ± 11.6 years). Area under the curve was similar for EOA/BSA (AUC 0.75, p < 0.001) and EOA/height (AUC 0.75, p < 0.001). A cutoff value of 0.60 cm2/m for EOA/height had a sensitivity of 84%, specificity of 61%, positive predictive value of 60% and negative predictive value of 84%. One-year survival from primary endpoint was significantly lower in patients with EOA/height ≤ 0.60 cm2/m (48 ± 5% vs 91 ± 4%, log-rank p < 0.001) than EOA/height > 0.60 cm2/m. The excess of risk of cardiovascular events seen in univariate analysis persists even after adjustment for other demonstrated adverse prognostic variables (HR 5.91, 95% CI 3.21-10.88, p < 0.001). In obese patients, there was an excess of risk in patients with EOA/height < 0.60 cm2/m (HR 10.2, 95% CI 3.5-29.5, p < 0.001), but not in EOA/BSA < 0.60 cm2/m2 (HR 0.14, 95% CI 0.14-1.4, p = 0.23).
Conclusions: We could identify a subgroup of patients with AS at high risk of cardiovascular events. Consequently, we recommend using EOA/height as a method of indexation in AS, especially in obese patients, with a cutoff of 0.60 cm2/m for identifying patients with higher cardiovascular risk.
期刊介绍：
Cardiovascular Ultrasound is an online journal, publishing peer-reviewed: original research; authoritative reviews; case reports on challenging and/or unusual diagnostic aspects; and expert opinions on new techniques and technologies. We are particularly interested in articles that include relevant images or video files, which provide an additional dimension to published articles and enhance understanding.
As an open access journal, Cardiovascular Ultrasound ensures high visibility for authors in addition to providing an up-to-date and freely available resource for the community. The journal welcomes discussion, and provides a forum for publishing opinion and debate ranging from biology to engineering to clinical echocardiography, with both speed and versatility.
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