R. Ly , S. Hascoet , N. Combes , P. Di Marco , C. Karsenty , I. Van Aershot , L. Guirgis , M. Ratsimandresy , J. Radojevic
{"title":"主动脉共动脉硬化的运动负荷超声心动图检查","authors":"R. Ly , S. Hascoet , N. Combes , P. Di Marco , C. Karsenty , I. Van Aershot , L. Guirgis , M. Ratsimandresy , J. Radojevic","doi":"10.1016/j.acvd.2024.07.007","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction</h3><p>Aortic coarctation (COA) is frequent congenital heart disease. It can be difficult to assess the indication for intervention or re-intervention in some cases.</p><p>Exercise stress echocardiography (ESE) can be helpful for hemodynamic evaluation in patients with COA or reCOA.</p></div><div><h3>Objective</h3><p>We aimed to determine ESE parameters predictive of intervention (angioplasty or surgery).</p></div><div><h3>Methods</h3><p>We retrospectively reviewed 94 ESE performed in children (<em>n</em> <!-->=<!--> <!-->14) and adults with native or repaired CoA and unclear indication for intervention in three centers in France.</p><p>Exercise test was performed concomitantly to echocardiography on the e-bike in semi-lying position. The protocol was adapted according to the age and the physical condition. Echocardiography protocol included left ventricular adaptation (LVA) to effort and peak systolic gradient (PSG) at isthmus and appearance of diastolic tail during effort.</p><p>We investigated risk marker associated with subsequent indication for intervention.</p></div><div><h3>Results</h3><p>Median age (min–max) was 26<!--> <!-->years (10–72). Intervention was subsequently performed in thirteen patients (14.7%).</p><p>Fifty-six patients (60.2%) had simple COA and 37 (39.8%) had complex anatomy, 24 (25%) had hypertension. Poor LVA was present in 13 (14%). Diastolic tail during effort appeared in 65 cases. The mean pic isthmus gradient 50<!--> <!-->±<!--> <!-->21<!--> <!-->mmHg (min: 15; max: 124).</p><p>Poor LVA was associated with more interventions (log-rank, <em>P</em> <!-->=<!--> <!-->0.004) (<span><span>Fig. 1</span></span>).</p><p>On univariate analysis presence of antihypertensive drugs (HR: 4.13, 95% CI [1.35–12.65]; <em>P</em> <!-->=<!--> <!-->0.013), systolic blood pressure at rest (HR: 1.04, 95% CI [1.011–1.072]; <em>P</em> <!-->=<!--> <!-->0.007); the lower exercise power (Watts) (HR: 0.98; 95% CI [0.96–0.99]; <em>P</em> <!-->=<!--> <!-->0.001); poor LVA (HR: 5.95, 95% CI [1.56–22.65]; <em>P</em> <!-->=<!--> <!-->0.009); peak systolic gradient at rest and on effort at isthmus (HR: 1.06, 95% CI [1.03–1.10] and HR: 1.04, 95% CI [1.02–1.06]) were significantly predictive of interventions (<span><span>Table 1</span></span>).</p></div><div><h3>Conclusion</h3><p>ESE is a useful tool for hemodynamic evaluation of COA. More severe forms that needed intervention showed less well adaption of the LV to effort and increase in the cardiac output and afterload.</p></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"117 8","pages":"Page S222"},"PeriodicalIF":2.3000,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Exercise stress echocardiography in coarctation of the aorta\",\"authors\":\"R. Ly , S. Hascoet , N. Combes , P. Di Marco , C. Karsenty , I. Van Aershot , L. Guirgis , M. Ratsimandresy , J. Radojevic\",\"doi\":\"10.1016/j.acvd.2024.07.007\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Introduction</h3><p>Aortic coarctation (COA) is frequent congenital heart disease. It can be difficult to assess the indication for intervention or re-intervention in some cases.</p><p>Exercise stress echocardiography (ESE) can be helpful for hemodynamic evaluation in patients with COA or reCOA.</p></div><div><h3>Objective</h3><p>We aimed to determine ESE parameters predictive of intervention (angioplasty or surgery).</p></div><div><h3>Methods</h3><p>We retrospectively reviewed 94 ESE performed in children (<em>n</em> <!-->=<!--> <!-->14) and adults with native or repaired CoA and unclear indication for intervention in three centers in France.</p><p>Exercise test was performed concomitantly to echocardiography on the e-bike in semi-lying position. The protocol was adapted according to the age and the physical condition. Echocardiography protocol included left ventricular adaptation (LVA) to effort and peak systolic gradient (PSG) at isthmus and appearance of diastolic tail during effort.</p><p>We investigated risk marker associated with subsequent indication for intervention.</p></div><div><h3>Results</h3><p>Median age (min–max) was 26<!--> <!-->years (10–72). Intervention was subsequently performed in thirteen patients (14.7%).</p><p>Fifty-six patients (60.2%) had simple COA and 37 (39.8%) had complex anatomy, 24 (25%) had hypertension. Poor LVA was present in 13 (14%). Diastolic tail during effort appeared in 65 cases. The mean pic isthmus gradient 50<!--> <!-->±<!--> <!-->21<!--> <!-->mmHg (min: 15; max: 124).</p><p>Poor LVA was associated with more interventions (log-rank, <em>P</em> <!-->=<!--> <!-->0.004) (<span><span>Fig. 1</span></span>).</p><p>On univariate analysis presence of antihypertensive drugs (HR: 4.13, 95% CI [1.35–12.65]; <em>P</em> <!-->=<!--> <!-->0.013), systolic blood pressure at rest (HR: 1.04, 95% CI [1.011–1.072]; <em>P</em> <!-->=<!--> <!-->0.007); the lower exercise power (Watts) (HR: 0.98; 95% CI [0.96–0.99]; <em>P</em> <!-->=<!--> <!-->0.001); poor LVA (HR: 5.95, 95% CI [1.56–22.65]; <em>P</em> <!-->=<!--> <!-->0.009); peak systolic gradient at rest and on effort at isthmus (HR: 1.06, 95% CI [1.03–1.10] and HR: 1.04, 95% CI [1.02–1.06]) were significantly predictive of interventions (<span><span>Table 1</span></span>).</p></div><div><h3>Conclusion</h3><p>ESE is a useful tool for hemodynamic evaluation of COA. More severe forms that needed intervention showed less well adaption of the LV to effort and increase in the cardiac output and afterload.</p></div>\",\"PeriodicalId\":55472,\"journal\":{\"name\":\"Archives of Cardiovascular Diseases\",\"volume\":\"117 8\",\"pages\":\"Page S222\"},\"PeriodicalIF\":2.3000,\"publicationDate\":\"2024-08-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Archives of Cardiovascular Diseases\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1875213624002286\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Archives of Cardiovascular Diseases","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1875213624002286","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
摘要
引言 主动脉缩窄(COA)是一种常见的先天性心脏病,在某些情况下很难评估介入治疗或再介入治疗的适应症。运动负荷超声心动图(ESE)有助于评估 COA 或再发 COA 患者的血流动力学。目的我们旨在确定预测介入治疗(血管成形术或手术)的 ESE 参数。方法我们回顾性地检查了法国三家中心为原发性或修复性CoA、介入指征不明确的儿童(n = 14)和成人实施的94例ESE。运动测试和超声心动图检查在电动自行车上以半卧位同时进行,测试方案根据患者的年龄和身体状况进行调整。超声心动图检查方案包括左心室对用力的适应性(LVA)、峡部收缩阶差峰值(PSG)以及用力时出现的舒张尾迹。结果中位年龄(最小-最大)为 26 岁(10-72)。56名患者(60.2%)为单纯COA,37名患者(39.8%)为复杂解剖,24名患者(25%)患有高血压。13名患者(14%)的 LVA 不佳。65 例患者在用力时出现舒张期尾部。平均皮瓣峡部梯度为 50 ± 21 mmHg(最小:15;最大:124)。13,95% CI [1.35-12.65];P = 0.013)、静息时收缩压(HR:1.04,95% CI [1.011-1.072];P = 0.007);运动功率(瓦特)越低(HR:0.98;95% CI [0.96-0.99];P = 0.001);LVA 较差(HR:5.95,95% CI [1.56-22.65];P = 0.009);静息时和峡部用力时收缩压阶差峰值(HR:1.06,95% CI [1.03-1.10]和 HR:1.04,95% CI [1.02-1.06])对干预具有显著预测作用(表 1)。需要干预的较严重病例显示左心室对用力的适应性较差,心输出量和后负荷增加。
Exercise stress echocardiography in coarctation of the aorta
Introduction
Aortic coarctation (COA) is frequent congenital heart disease. It can be difficult to assess the indication for intervention or re-intervention in some cases.
Exercise stress echocardiography (ESE) can be helpful for hemodynamic evaluation in patients with COA or reCOA.
Objective
We aimed to determine ESE parameters predictive of intervention (angioplasty or surgery).
Methods
We retrospectively reviewed 94 ESE performed in children (n = 14) and adults with native or repaired CoA and unclear indication for intervention in three centers in France.
Exercise test was performed concomitantly to echocardiography on the e-bike in semi-lying position. The protocol was adapted according to the age and the physical condition. Echocardiography protocol included left ventricular adaptation (LVA) to effort and peak systolic gradient (PSG) at isthmus and appearance of diastolic tail during effort.
We investigated risk marker associated with subsequent indication for intervention.
Results
Median age (min–max) was 26 years (10–72). Intervention was subsequently performed in thirteen patients (14.7%).
Fifty-six patients (60.2%) had simple COA and 37 (39.8%) had complex anatomy, 24 (25%) had hypertension. Poor LVA was present in 13 (14%). Diastolic tail during effort appeared in 65 cases. The mean pic isthmus gradient 50 ± 21 mmHg (min: 15; max: 124).
Poor LVA was associated with more interventions (log-rank, P = 0.004) (Fig. 1).
On univariate analysis presence of antihypertensive drugs (HR: 4.13, 95% CI [1.35–12.65]; P = 0.013), systolic blood pressure at rest (HR: 1.04, 95% CI [1.011–1.072]; P = 0.007); the lower exercise power (Watts) (HR: 0.98; 95% CI [0.96–0.99]; P = 0.001); poor LVA (HR: 5.95, 95% CI [1.56–22.65]; P = 0.009); peak systolic gradient at rest and on effort at isthmus (HR: 1.06, 95% CI [1.03–1.10] and HR: 1.04, 95% CI [1.02–1.06]) were significantly predictive of interventions (Table 1).
Conclusion
ESE is a useful tool for hemodynamic evaluation of COA. More severe forms that needed intervention showed less well adaption of the LV to effort and increase in the cardiac output and afterload.
期刊介绍:
The Journal publishes original peer-reviewed clinical and research articles, epidemiological studies, new methodological clinical approaches, review articles and editorials. Topics covered include coronary artery and valve diseases, interventional and pediatric cardiology, cardiovascular surgery, cardiomyopathy and heart failure, arrhythmias and stimulation, cardiovascular imaging, vascular medicine and hypertension, epidemiology and risk factors, and large multicenter studies. Archives of Cardiovascular Diseases also publishes abstracts of papers presented at the annual sessions of the Journées Européennes de la Société Française de Cardiologie and the guidelines edited by the French Society of Cardiology.