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三维超声心动图参数对二叶式主动脉瓣重度狭窄患者经导管主动脉瓣置换术后左心室逆重构的评估价值

Value of three-dimensional echocardiographic parameters for left ventricular reverse remodeling after transcatheter aortic valve replacement in patients with severe bicuspid aortic valve stenosis

    摘要
  • 摘要:
    目的 探讨三维超声心动图参数对二叶式主动脉瓣(BAV)重度狭窄患者行经导管主动脉瓣置换术(TAVR)后发生左心室逆重构(LVRR)的评估价值。
    方法 选取2021年1月-2024年4月医院收治的140例BAV重度狭窄患者, 所有患者均接受TAVR治疗, 并完成三维超声心动图检查。根据是否发生LVRR, 将患者分为发生组(69例)与未发生组(71例)。比较2组临床资料及三维超声心动图参数左心室重构指数(LVRI)、左心室质量指数(LVMI)、左心室舒张末期容积指数(LVEDVI)、左心室收缩末期容积指数(LVESVI)。采用Logistic回归分析法分析BAV重度狭窄患者TAVR后发生LVRR的影响因素, 绘制受试者工作特征(ROC)曲线分析三维超声心动图参数对BAV重度狭窄患者TAVR后发生LVRR的预测价值。
    结果 140例BAV重度狭窄患者TAVR后, 69例发生LVRR, 发生率为49.29%;与未发生组比较, 发生组LVMI、LVEDVI、LVRI、LVESVI值均更低, 差异有统计学意义(P < 0.05);发生组心功能分级≥Ⅲ级占比、钙化积分均低于未发生组, 差异有统计学意义(P < 0.05);Logistic回归分析结果显示, 心功能分级 <Ⅲ级、LVMI、LVEDVI、LVESVI、LVRI值低是BAV重度狭窄患者TAVR后发生LVRR的保护因素; ROC曲线显示, LVRI、LVMI、LVEDVI、LVESVI单独预测TAVR后发生LVRR的曲线下面积(AUC)及其95% CI为0.876(0.810~0.926)、0.878(0.812~0.927)、0.758(0.678~0.826)、0.786(0.709~0.851), 联合模型、预测模型AUC (95% CI)为0.911(0.852~0.953)、0.947(0.895~0.978), 联合模型、预测模型效能均较高。
    结论 LVRI、LVMI、LVEDVI、LVESVI与BAV重度狭窄患者TAVR后LVRR密切相关, 均为BAV重度狭窄患者发生LVRR的影响因素, 以上指标联合检测对术后发生LVRR具有较高的预测价值。

     

    Abstract:
    Objective To explore the evaluation value of three-dimensional echocardiographic parameters for left ventricular reverse remodeling (LVRR) after transcatheter aortic valve replacement (TAVR) in patients with severe bicuspid aortic valve (BAV) stenosis.
    Methods A total of 140 patients with severe BAV stenosis admitted to our hospital from January 2021 to April 2024 were selected.All patients underwent TAVR surgery and completed three-dimensional echocardiographic examinations.According to whether LVRR occurred, the patients were divided into occurrence group (69 cases) and non-occurrence group (71 cases).Clinical data and three-dimensional echocardiographic parametersleft ventricular remodeling index (LVRI), left ventricular mass index (LVMI), left ventricular end-diastolic volume index (LVEDVI), and left ventricular end-systolic volume index (LVESVI)were compared between the two groups.Logistic regression analysis was used to analyze the risk factors for LVRR after TAVR in patients with severe BAV stenosis.Receiver operating characteristic (ROC) curves were plotted to analyze the predictive value of three-dimensional echocardiographic parameters for LVRR after TAVR in patients with severe BAV stenosis.
    Results Among the 140 patients with severe BAV stenosis after TAVR, 69 cases developed LVRR, with an incidence rate of 49.29%.Compared with the non-occurrence group, the occurrence group had lower values of LVMI, LVEDVI, and LVESVI, and the differences were statistically significant (P < 0.05).The proportion of patients with cardiac function classification ≥ grade Ⅲ and the calcification score in the occurrence group were lower than those in the non-occurrence group, and the differences were statistically significant (P < 0.05).Logistic regression analysis results showed that cardiac function classification < grade Ⅲ, low values of LVMI, LVEDVI, LVESVI, and LVRI were protective factors for LVRR after TAVR in patients with severe BAV stenosis.ROC curves showed that the areas under the curve (AUCs) and 95% CI of LVRI, LVMI, LVEDVI, and LVESVI for predicting LVRR after TAVR alone were 0.876(0.810 to 0.926), 0.878(0.812 to 0.927), 0.758(0.678 to 0.826), and 0.786(0.709 to 0.851), respectively.The AUCs (95% CI) of the combined model and the predictive model were 0.911(0.852 to 0.953) and 0.947(0.895 to 0.978), respectively, indicating high efficacy of both models.
    Conclusion After TAVR, LVRI, LVMI, LVEDVI, and LVESVI are closely related to LVRR in patients with severe BAV stenosis and are influencing factors for LVRR occurrence in these patients.The combined detection of these indicators has a high predictive value for LVRR after surgery.

     

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