medvisМедицинская визуализацияMedical Visualization1607-07632408-9516RDS-Media Ltd.10.24835/1607-0763-957medvis-957Research ArticleСЕРДЦЕ И СОСУДЫHEART AND VESSELSСравнение эхокардиографического и катетерного методов в диагностике тяжелого стеноза аортального клапанаComparison of echocardiographic and catheter methods in the diagnosis of severe aortic valve stenosishttps://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 

6, Stasova str., Penza 440071

cardio-penza@yandex.ruhttps://orcid.org/0000-0002-7338-9462БабуковР. М.BabukovR. M.

Бабуков Руслан Медарисович – врач кардиолог-врач ультразвуковой диагностики

440071 Пенза, ул. Стасова, 6

Тел.: +7-937-421-69-69

Ruslan M. Babukov – doctor cardiologist, ultrasound diagnosis doctor 

6, Stasova str., Penza 440071

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

6, Stasova str., Penza 440071

Fbartosh@km.ruhttps://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 

6, Stasova str., Penza 440071

goralen1@mail.ruФГБУ “Федеральный центр сердечно-сосудистой хирургии” Минздрава РоссииРоссияFederal Centre for Cardiovascular SurgeryRussian Federation2022110820222633445Copyright © 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/957Цель исследования

Цель исследования. 1. Оценить согласованность измерений, проведенных методом эхокардиографии, с данными катетеризации при  тяжелом стенозе аорты.

Материал и методы

Материал и методы. Проспективно были собраны данные 70 пациентов (из них 38 женщин), средний возраст 72 ± 6 лет, которым перед транскатетерной имплантацией аортального клапана (апикальным доступом) проводили катетеризацию сердца с одномоментным эхосканированием показателей, необходимых для оценки тяжести стеноза аортального клапана.

Критерии включения в исследование: изолированный стеноз аортального клапана с эхокардиографическими характеристиками, соответствующими тяжелому стенозу: эффективная площадь отверстия аортального клапана (ЕOA) <1 cм2, максимальный градиент на аортальном клапане (Gmax) ≥64 мм рт.ст., средний градиент на аортальном клапане (Gmean) ≥40 мм рт.ст.

Критерии исключения

Критерии исключения: пациенты с индексируемым ударным объемом ЛЖ к площади поверхности тела <35 мл/м2, сниженной фракцией выброса <50%, пациенты с сочетанной нетривиальной регургитацией на аортальном и митральном клапанах и пациенты с сочетанным значимым стенозом митрального клапана, ускоренным кровотоком в выносящем тракте левого желудочка (выше 1,1 м/c) и постоянной  формой фибрилляции предсердий.

Результаты

Результаты. Метод линейной регрессии продемонстрировал слабую корреляционную связь между показателями Gmax (допплер) и Pmean, r = 0,48, р = 0,001. Отмечались высокие значения средней разницы (СР) между двумя методами при сравнении Бленда–Альтмана (СР = 19 ± 17 мм рт.ст.) и низкие значения внутриклассовой корреляции (ICC = 0,34). После корректировки показателей Gmax (допплер) на коэффициент восстановления давления значительно улучшилась корреляционная связь между методами, r = 0,84, р ≤ 0,001, отмечалось снижение показателей средней разницы между двумя методами (СР = 3,15 ± 12 мм рт.ст.) с высокодостоверными значениями внутриклассовой корреляции (ICC = 0,89).

Аналогично низкая корреляционная связь с высокими значениями средней разницы наблюдалась и при сравнении ЕОА (допплер) и ЕОА (катетеризация), r = 0,55, р = 0,01, СР = 0,21 ± 0,15 см2, ICC = 0,53, с улучшением согласованности между методами после корректировки на коэффициент восстановления давления, r = 0,9, р ≤ 0,001, СР = 0,04 ± 0,08 см2, ICC = 0,92.

Сравнение показателей Gmean (допплер) c катетерным Pmean продемонстрировало высокую корреляционную связь между методами, г = 0,7, р ≤ 0,001, отмечались относительно низкие показатели средней разницы между двумя методами (СР = 7,2 ± 22 мм рт.ст) и значимая внутриклассовая корреляция (ICC = 0,72).

Методом анализа множественной регрессии выявлено, что диаметр синотобулярного соединения является значимым фактором, оказывающим влияние на согласованость данных эхокардиографии и катетеризации OR 1,2 (95%ДИ 0,09; 2,9).

Выводы

Выводы

Purpose

Purpose. 1. Assess the consistency of echocardiographic measurements with catheterization data in severe aortic stenosis.

Materials and methods

Materials and methods. Prospectively, 70 patients (mean age 72 ± 6 years, 38 females) have been included. All patient underwentcardiac catheterization with single-meter echoscanning of the parameters necessary to assess the severity of aortic valve stenosis before transcatheter aortic valve implantation. Inclusion criteria were isolated aortic stenosis (EOA <1 cm2, Gmax ≥64 mm Hg, Gmean ≥40 mm Hg. Exclusion criteria were LV stroke volume index <35 ml/m2 and a reduced EF <50%, concomitant nontrivial regurgitation of the aortic and mitral valves.

Result

Result. The linear regression method showed a weak correlation between the Gmax (Doppler) and Pmean indices, r = 0.48, p = 0.001. Revealed high values of the average difference between the two methods in comparison with the Blent–Altman (SR 19 ± 17 mm Hg.) and low intraclasscorrelation values (ICC = 0.34). After adjusting the Gmax (Doppler) indices for the pressure recovery factor, the correlation between the methods r = 0.84, p ≤ 0.001, significantly improved. There was a decrease in the mean indices, the difference between the two HR methods was (3.15 ± 12 mm Hg.) with highly significant intraclasscorrelation values (ICC = 0.89). Similarly, a low correlation with high values of the average difference was observed when comparing EOA (Doppler) and EOA (catheterization) r = 0.55, p = 0.01, SR 0.21 ± 0.15 cm2, ICC = 0.53. With an improvement in the correlation between the methods after adjustment for the pressure recovery coefficient, r = 0.9, p ≤ 0.001, CP = 0.04 ± 0.08 cm2, ICC = 0.92. Comparison of Gmean (Doppler) indices with catheter Pmean has showed a high correlation between the methods, r = 0.7, p ≤ 0.001, there were relatively low indices of the average difference between the two methods of HR = 7.2 ± 22 mm Hg and a significant intraclass correlation (ICC = 0.72). The method of analysis of multiple regression revealed that the diameter of the sinotubular ridge was a significant factor affecting the correlation between echocardiography and catheterization data, OR 1.2 (CI 0.09; 2.9).

Conclusions

Conclusions

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