medvisМедицинская визуализацияMedical Visualization1607-07632408-9516RDS-Media Ltd.10.24835/1607-0763-1006medvis-1006Research ArticleСЕРДЦЕ И СОСУДЫHEART AND VESSELSСравнительный анализ эхокардиографических показателей времени ускорения и соотношения времени ускорения к общему времени выброса левого желудочка с показателями катетеризации в оценке тяжести аортального стеноза у пациентов с Normal flow High GradientComparative analysis of echocardiographic indicators of acceleration time and the ratio of acceleration time to total left ventricular ejection time with catheterization indicators in assessing the severity of aortic stenosis in patients with Normal flow High Gradienthttps://orcid.org/0000-0001-6089-9722БазылевВ. В.BazylevV. V.

Базылев Владлен Владленович – доктор мед. наук, профессор, главный врач

440071 Пенза, ул. Стасова, 6

Vladlen V. Bazylev – Doct. of Sci. (Med.), Chief doctor 

440071, Penza, Stasova str., 6

https://orcid.org/0000-0002-7338-9462БабуковР. М.BabukovR. M.

Бабуков Руслан Медарисович – врач кардиолог-врач ультразвуковой диагностики +7-937-421-69-69

440071 Пенза, ул. Стасова, 6

Ruslan M. Babukov – doctor cardiologist, ultrasound diagnosis doctorPhone: +7-937-421-69-69

440071, Penza, Stasova str., 6

ruslan.babukov@mail.ruhttps://orcid.org/0000-0001-5482-3211БартошФ. Л.BartoshF. L.

Бартош Фёдор Леонидович – канд. мед. наук, заведующий отделением функциональной и ультразвуковой диагностики

440071 Пенза, ул. Стасова, 6

Fedor L. Bartosh – Cand. of Sci. (Med.), heads of the department of the of functional and ultrasound diangistics

440071, Penza, Stasova str., 6

https://orcid.org/0000-0002-3210-3974ЛёвинаА. В.LevinaA. V.

Лёвина Алёна Витальевна – врач ультразвуковой диагностики

440071 Пенза, ул. Стасова, 6

Alena V. Levina – ultrasound diagnosis doctor

440071, Penza, Stasova str., 6

ФГБУ “Федеральный центр сердечно-сосудистой хирургии” Минздрава РоссииРоссияFederal Centre for Cardiovascular SurgeryRussian Federation20221505202226291100Copyright © Базылев В.В., Бабуков Р.М., Бартош Ф.Л., Лёвина А.В., 20222022Базылев В.В., Бабуков Р.М., Бартош Ф.Л., Лёвина А.В.Bazylev V.V., Babukov R.M., Bartosh F.L., Levina A.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://medvis.rdsmedia.ru/jour/article/view/1006

Цель исследования: 1. Сравнить эхокардиографические показатели времени ускорения (АТ), соотношения времени ускорения к общему времени выброса левого желудочка (AT/ET) и общего времени выброса левого желудочка (ЕТ) с данными прямой катетеризации сердца и оценить предсказательную способность тяжелого аортального стеноза (АС) у пациентов с сохраненным ударным объемом ЛЖ и высокими трансаортальными градиентами. 2. Определить пороговые значения для показателей АТ и АТ/ЕТ в диагностике тяжелого АС.Материал и методы. Проспективно собраны данные 75 пациентов, средний возраст 72 ± 6 лет, которым планировалась транскатетерная имплантация аортального клапана (АК). Критерии включения: изолированный стеноз АК с эхокардиографическими характеристиками, соответствующими тяжелому стенозу с сохраненным ударным объемом ЛЖ и высокими трансаортальными градиентами. Всем исследуемым перед транскатетерной имплантацией АК проводили катетеризацию сердца с измерением показателей, необходимых для оценки тяжести АС.Результаты. Анализ линейной регрессии продемонстрировал статистически значимую корреляционную связь между показателями АT и AT/ET, р < 0,05. Кривая ROC-анализа продемонстрировала наибольшую диагностическую способность в оценке тяжести АС для показателя AT/ET, значение площади под кривой AUC 87 (р < 0,001), несколько меньшую диагностическую способность для показателя АТ, значение под кривой АUC 0,8 (р < 0,001). Чувствительность и специфичность показателя AT/ET в определении тяжелого АС составили 84 и 79% соответственно, для показателя АТ чувствительность – 82% и специфичность – 46%. Были выявлены пороговые значения для показателя АТ и АТ/ЕТ в определении тяжелого стеноза АК – 105 и 0,35 мс соответственно.Выводы. 1. Эхокардиографические показатели АТ и АТ/ЕТ обладают сильной корреляционной связью с данными катетеризации и высокой предсказательной способностью тяжелого АС у пациентов с сохраненным ударным объемом ЛЖ и высокими трансаортальными градиентами. 2. Пороговые значения показателей АТ 105 мс и АТ/ЕТ 0,35 мс могут с высокой долей вероятности диагностировать тяжелый АС.

Purpose. 1. To compare the ultrasound indices of time in comparison (AT), cardiac catheterization evaluating severity (AT/ET) with the indices of direct cardiac catheterization and assess the prognostic ability in the assessment of severity of AS in patients with Normal flow High Gradient 2. To determine the threshold values for the indicators of AT and AT/ET in predicting severe AS.Materials and methods. This is prospective single center study. We evaluated results of treatment of 75 patients with mean age 72 ± 6 years that were planned for aortic valve replacement due to aortic stenosis. Inclusion criteria: isolated aortic valve stenosis with ultrasound characteristics of severe AS. Before transcatheter aortic valve implantation, all patients underwent cardiac catheterization with the measurement of parameters necessary to assess the severity of AS.Results. Linear regression analysis showed a statistically significant correlation between AT and AT/ET (p < 0.05). The ROC-analysis has showed the highest predictive ability in assessing the severity of aortic stenosis for the AT / ET index (AUC – 87%, p < 0.001), slightly lower predictive power for the AT parameter (AUC – 80%, p < 0.001). The sensitivity and specificity of the AT / ET indicator in determining severe AS was 84% and 79%, respectively. For the AT indicator, the sensitivity was 82% and the specificity was 46%. The threshold values for AT and AT / ET were 105 ms and 0.35, respectively.Conclusions. 1. AT and AT / ET have a strong correlation with catheterization data and a high predictive ability of severe aortic stenosis in patients with Normal Flow High Gradient patients. 2. Threshold values for AT and AT /ET, that predict a high probability of AS, were 105ms and 0.35ms respectively. The study showed, echocardiographic indicators AT and AT ET have a strong correlation with catheterization data and a high predictive ability of severe aortic stenosis in patients with Normal Flow High Gradient patients. Threshold values for AT and AT ET, that predict a high probability of AS, were 105 ms and 0.35 ms respectively.

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The authors declare that there are no conflicts of interest present.