超声心动图追踪主动脉瓣狭窄的进展。

IF 2.4 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
Clay Sherrill, Jenna Port, Mohamad Wahoud, Ben Koethe, Sharanya Mohanty, Brian C Downey, Ayan Patel, Benjamin S Wessler
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引用次数: 0

摘要

背景:经胸超声心动图(TTE)用于评估主动脉狭窄(AS)的严重程度和跟踪疾病进展。随着该领域转向研究阻止疾病进展的医学疗法,需要可靠的非侵入性成像标记物,这些标记物对疾病进展的微小变化敏感,以实现有效的试验设计。通常获得的基于te的渐进性(非严重)AS严重程度测量的信噪比是未知的。方法:这是一项回顾性研究,在三级转诊中心(塔夫茨医学中心,马萨诸塞州波士顿)完成。一组进行性AS患者在30天内(在没有瓣膜干预的情况下)做了两次tts,另一组进行性AS患者的tts间隔≥1年,同样没有瓣膜干预。通过连续性方程、峰值流速和平均梯度计算主动脉瓣面积(AVA)的一致限(LOA)和类内相关(ICC)。计算每个血流动力学评估的Cohen's d统计量(d)和一个复合标记物,以评估检测疾病进展的敏感性,并将测量变异性归一化。结果:可重复性队列包括24例患者。进展队列包括35例患者。年龄中位数为70岁(四分位数差[IQR] 13)。女性22例(37.3%)。在进展队列中,tte之间的中位时间为2.2年(IQR为3.1年)。在可重复性队列中,AVA LOA为-0.7 ~ 0.8,ICC = 0.61;峰值流速LOA为-149.0 ~ + 126.7,ICC = 0.29;平均梯度LOA为-16.2 ~ 12.2,ICC = 0.06。AVA年化变化的d统计量为-0.29,最大流速年化变化的d统计量为0.46,平均梯度年化变化的d统计量为0.55。包括所有三个血流动力学指标的复合d统计量为0.45。结论:AS严重程度的标准TTE标记物在检测AS进展方面具有不同的敏感性。对于进行性(非严重)AS患者,平均梯度具有最高的信噪比,可能是最可靠的基于tte的疾病进展评估。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Tracking progression of aortic stenosis with echocardiography.

Tracking progression of aortic stenosis with echocardiography.

Tracking progression of aortic stenosis with echocardiography.

Background: Transthoracic echocardiography (TTE) is used to assess aortic stenosis (AS) severity and track disease progression. As the field moves to study medical therapies to halt disease progression, reliable non-invasive imaging markers that are sensitive to small changes in disease progression are needed to enable efficient trial designs. The signal-to-noise ratio of commonly obtained TTE-based measures of progressive (non-severe) AS severity is unknown.

Methods: This is a retrospective study of TTEs done at a tertiary referral centre (Tufts Medical Center, Boston MA). A cohort of patients with progressive AS who had two TTEs done within 30 days (in the absence of valve intervention) and a cohort of progressive AS patients with TTEs ≥ 1 year apart, also without valvular intervention, were assembled. Limits of agreement (LOA) and intraclass correlation (ICC) were calculated for aortic valve area (AVA) by continuity equation, peak velocity, and mean gradient. Cohen's d-statistic (d) was calculated for each hemodynamic assessment and a composite marker to assess sensitivity for detecting disease progression normalised to measurement variability.

Results: The reproducibility cohort included 24 patients. The progression cohort included 35 patients. The median age was 70 years (interquartile range [IQR] 13). 22 patients (37.3%) were female. In the progression cohort, the median time between TTEs was 2.2 years (IQR 3.1 years). In the reproducibility cohort, AVA LOA were -0.7 to 0.8, ICC = 0.61; peak velocity LOA were -149.0 to + 126.7, ICC = 0.29; and mean gradient LOA were -16.2 to 12.2, ICC = 0.06. The d-statistic for annualised change in AVA was -0.29, the d-statistic for annualised change in maximum velocity was 0.46, the d-statistic for mean gradient was 0.55. The d-statistic for a composite, including all three hemodynamic markers, was 0.45.

Conclusions: Standard TTE markers of AS severity have variable sensitivity for detecting AS progression. For patients with progressive (non-severe) AS, mean gradient has the highest signal-to-noise ratio and may be the most reliable TTE-based assessment of disease progression.

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来源期刊
Echo Research and Practice
Echo Research and Practice CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
6.70
自引率
12.70%
发文量
11
审稿时长
8 weeks
期刊介绍: Echo Research and Practice aims to be the premier international journal for physicians, sonographers, nurses and other allied health professionals practising echocardiography and other cardiac imaging modalities. This open-access journal publishes quality clinical and basic research, reviews, videos, education materials and selected high-interest case reports and videos across all echocardiography modalities and disciplines, including paediatrics, anaesthetics, general practice, acute medicine and intensive care. Multi-modality studies primarily featuring the use of cardiac ultrasound in clinical practice, in association with Cardiac Computed Tomography, Cardiovascular Magnetic Resonance or Nuclear Cardiology are of interest. Topics include, but are not limited to: 2D echocardiography 3D echocardiography Comparative imaging techniques – CCT, CMR and Nuclear Cardiology Congenital heart disease, including foetal echocardiography Contrast echocardiography Critical care echocardiography Deformation imaging Doppler echocardiography Interventional echocardiography Intracardiac echocardiography Intraoperative echocardiography Prosthetic valves Stress echocardiography Technical innovations Transoesophageal echocardiography Valve disease.
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