超声心动图评估与老年性心脏瓣膜疾病患者预后的关系
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摘要
目的探讨超声心动图评估瓣环直径指数、心房横径比值和反流速度与老年性心脏瓣膜疾病患者预后的关系。方法选取我院心血管内科于2013年3月至2016年2月门诊或住院老年性心脏瓣膜疾病患者100例作为观察组,同期纳入100名健康人群作为对照组,分别对2组人群的超声心动图瓣环直径指数、心房横径比值和反流速度进行检测,应用COX风险评估模型对老年性心脏瓣膜疾病患者的预后进行相关性分析。结果经过超声检测,观察组有无不良预后组的左心室舒张期内径(LVDd)值、左房内径(LAD)值、瓣环直径指数、心房横径比值、最大反流速度明显高于对照组,而左室射血分数(LVEF)值明显低于对照组,差异有统计学意义(P<0.05),且有无不良预后2组的超声心动图指标比较差异有统计学意义(P<0.05)。瓣环直径指数及最大反流速度是影响老年性心脏瓣膜疾病患者死亡或重大心血管事件发生的独立危险因素。结论超声心动图对老年性瓣膜疾病患者瓣环直径指数、心房横径比及反流速度的评估可进一步对患者病情的严重程度和预后情况进行评估,从而指导临床瓣膜手术方案的选择,使更多患者在手术中受益,可降低死亡率,改善患者的预后。
Objective To study the echocardiographic assessment of valve ring diameter index, atrial transverse diameter ratio and reflux velocity and their relationship with prognosis in elderly patients with valvular diseases.Methods One hundred patients with valvular diseases were treated in our hospital from March 2013 to February2016,100 healthy subjects were included in the study at the same time as the control group. Echocardiographic valve ring diameter index, atrial transverse diameter ratio and reflux velocity were measured in the two groups, and the prognosis of elderly patients with valvular heart disease was analyzed by COX fractional evaluation model. Result The LVDd value, LAD value, annulus diameter index, atrial transverse diameter ratio and maximal reflux velocity in the observation group were significantly higher than those in the control group, but the LVEF value was significantly lower than that in the control group(P<0.05). There was also a significant difference in echocardiographic indexes between the two groups with and without adverse prognosis. Valve ring diameter index and maximum reflux velocity are independent risk factors for death or major cardiovascular events in elderly patients with valvular heart disease. Conclusion Echocardiographic assessment of valvering diameter index, atrial transverse diameter ratio and reflux velocity in elderly patients with valvular heart disease can further assess the severity and prognosis of the disease, thus guiding the selection of clinical valve surgery options, so as to benefit more patients during the operation, reduce mortality and improve the patient′s condition.
Objective To study the echocardiographic assessment of valve ring diameter index, atrial transverse diameter ratio and reflux velocity and their relationship with prognosis in elderly patients with valvular diseases.Methods One hundred patients with valvular diseases were treated in our hospital from March 2013 to February2016,100 healthy subjects were included in the study at the same time as the control group. Echocardiographic valve ring diameter index, atrial transverse diameter ratio and reflux velocity were measured in the two groups, and the prognosis of elderly patients with valvular heart disease was analyzed by COX fractional evaluation model. Result The LVDd value, LAD value, annulus diameter index, atrial transverse diameter ratio and maximal reflux velocity in the observation group were significantly higher than those in the control group, but the LVEF value was significantly lower than that in the control group(P<0.05). There was also a significant difference in echocardiographic indexes between the two groups with and without adverse prognosis. Valve ring diameter index and maximum reflux velocity are independent risk factors for death or major cardiovascular events in elderly patients with valvular heart disease. Conclusion Echocardiographic assessment of valvering diameter index, atrial transverse diameter ratio and reflux velocity in elderly patients with valvular heart disease can further assess the severity and prognosis of the disease, thus guiding the selection of clinical valve surgery options, so as to benefit more patients during the operation, reduce mortality and improve the patient′s condition.
引文
[1]江跃.老年性心脏瓣膜病的超声心动图特点及临床诊断准确率研究[J].检验医学,2016,31(9):31-32.
[2]蒙振明,陈巧玲.超声心动图对老年钙化性心脏瓣膜病的诊断价值[J].蚌埠医学院学报,2016,41(6):793-796.
[3]李康,杨重庆,张瑞生,等.经胸超声心动图对老年患者左心瓣膜钙化诊断的准确性评价[J].中华老年医学杂志,2017,36(4):395-399.
[4]郭文波,徐会圃,刘长梅.脂蛋白相关磷脂酶A2、脂蛋白(a)活性水平与退行性心脏瓣膜病的相关性[J].临床心血管病杂志,2016,35(4):359-363.
[5] Varvarousis D,Polytarchou K,Daskalopoulos N,et al. Senile cardiac amyloidosis:clinical manifestations and non-invasive diagnostic approach.[J]. Hellen J Cardiol,2017,58(1):60.
[6] Latib A,Mangieri A,Agricola E,et al. Percutaneous bicuspidalization of the tricuspid valve using the MitraClip system[J].Int J Cardiovasc Imag,2016,33(2):1-2.
[7] Narotsky DL,Castano A,Weinsaft JW,et al. Wild-type transthyretin cardiac amyloidosis:novel insights from advanced imaging[J]. Canad J Cardiol,2016,32(9):1166.e1-1166.e10.
[8] Shiota T. Role of echocardiography for catheter-based management of valvular heart disease[J]. J Cardiol,2017,69(1):66-73.
[2]蒙振明,陈巧玲.超声心动图对老年钙化性心脏瓣膜病的诊断价值[J].蚌埠医学院学报,2016,41(6):793-796.
[3]李康,杨重庆,张瑞生,等.经胸超声心动图对老年患者左心瓣膜钙化诊断的准确性评价[J].中华老年医学杂志,2017,36(4):395-399.
[4]郭文波,徐会圃,刘长梅.脂蛋白相关磷脂酶A2、脂蛋白(a)活性水平与退行性心脏瓣膜病的相关性[J].临床心血管病杂志,2016,35(4):359-363.
[5] Varvarousis D,Polytarchou K,Daskalopoulos N,et al. Senile cardiac amyloidosis:clinical manifestations and non-invasive diagnostic approach.[J]. Hellen J Cardiol,2017,58(1):60.
[6] Latib A,Mangieri A,Agricola E,et al. Percutaneous bicuspidalization of the tricuspid valve using the MitraClip system[J].Int J Cardiovasc Imag,2016,33(2):1-2.
[7] Narotsky DL,Castano A,Weinsaft JW,et al. Wild-type transthyretin cardiac amyloidosis:novel insights from advanced imaging[J]. Canad J Cardiol,2016,32(9):1166.e1-1166.e10.
[8] Shiota T. Role of echocardiography for catheter-based management of valvular heart disease[J]. J Cardiol,2017,69(1):66-73.