medvisМедицинская визуализацияMedical Visualization1607-07632408-9516RDS-Media Ltd.10.24835/1607-0763-2020-4-74-80medvis-972Research ArticleСЕРДЦЕ И СОСУДЫHEART AND VESSELSСравнение гемодинамических параметров трансаортального кровотока у пациентов с аортальным стенозом в зависимости от двустворчатого или трехстворчатого строения клапанаComparison of the hemodynamic parameters of transaortic blood flow in patients with aortic stenosis depending on the bicuspid or tricuspid valve structurehttps://orcid.org/0000-0001-6089-9722БазылевВ. В.BazylevV. V.

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

440071 Пенза, ул. Стасова, д. 6, Российская Федерация

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

6, Stasova str., Penza, 440071, Russian Federation

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

Бабуков Руслан Медарисович – врач ультразвуковой диагностики

440071 Пенза, ул. Стасова, д. 6, Российская Федерация

Тел.: +7-937-421-69-69

 

Ruslan M. Babukov – doctor cardiologist, ultrasound diagnosis doctor

6, Stasova str., Penza, 440071, Russian Federation

Phone: +7-937-421-69-69

cardio-penza@yandex.ruhttps://orcid.org/0000-0001-5482-3211БартошФ. Л.BartoshF. L.

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

440071 Пенза, ул. Стасова, д. 6, Российская Федерация

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

6, Stasova str., Penza, 440071, Russian Federation

https://orcid.org/0000-0002-3210-3974ГоршковаА. В.GorshkovaA. V.

Горшкова Алёна Витальевна – врач ультразвуковой диагностики

440071 Пенза, ул. Стасова, д. 6, Российская Федерация

Alena V. Gorshkova – ultrasound diagnosis doctor Federal Centre for Cardiovascular Surgery

6, Stasova str., Penza, 440071, Russian Federation

ФГБУ “Федеральный центр сердечно-сосудистой хирургии” Минздрава России, ПензаРоссияFederal Centre for Cardiovascular Surgery, PenzaRussian Federation2020101220202447480Copyright © Базылев В.В., Бабуков р.М., Бартош Ф.Л., Горшкова А.В., 20202020Базылев В.В., Бабуков р.М., Бартош Ф.Л., Горшкова А.В.Bazylev V.V., Babukov R.M., Bartosh F.L., Gorshkova 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/972Цель исследования

Цель исследования: сравнение гемодинамических параметров трансаортального кровотока у пациентов с аортальным стенозом в зависимости от двустворчатого или трехстворчатого строения аортального клапана (АК).

Материал и методы

Материал и методы. Проведено исследование 180 пациентов с изолированным стенозом АК с дву- и трехстворчатым строением. Пациенты были ранжированы на 3 подгруппы сравнения по площади эффективного отверстия АК от 4 до 1,5 см2, от 1,5 до 1 см2 и менее 1 см2. Проводилось эхокардиографическое исследование с вычислением всех необходимых параметров для исследования.

Результаты

Результаты. Подгруппы сравнения были сопоставимы по показателям площади эффективного отверстия (AVA), индекса площади эффективного отверстия (IAVA), индекса массы тела (BMI), индекса УО ЛЖ и ФВ ЛЖ (р > 0,05). Однако показатели Vmax, Gmean и показатель времени ускорения (AT) у пациентов с двустворчатым строением АК во всех подгруппах сравнения были значительно больше, чем у пациентов с трехстворчатым строением. Подгруппа сравнения с AVA от 4 до 1,5 см2: Vmax 2,8 ± 9 и 2,5 ± 6 м/с, p = 0,02; Gmean 18,6 ± 7,2 и 15 ± 6 мм рт.ст., р = 0,03; AT 82 ± 12 и 70 ± 10 мс, p = 0,002. Подгруппа сравнения с AVA от 1,5 до 1 см2: Vmax 3,7 ± 0,8 и 3,5 ± 0,6 м/с, p = 0,02; средний трансаортальный градиент 37 ± 10 и 29 ± 5 мм рт.ст., р = 0,04; AT 103 ± 11 и 94 ± 10 мс, p = 0,02. Подгруппа сравнения с площадью эффективного отверстия менее 1 см2: Vmax 5,7 ± 1,2 и 4,7 ± 0,7 м/с, p = 0,001; Gmean 54 ± 15 и 43 ± 11 мм рт.ст., р < 0,001; AT 127 ± 20 и 112 ± 10 мс, p = 0,002.

Заключение

Заключение. Эхокардиографические показатели Vmax, Gmean у пациентов с двустворчатым строением АК имеют более высокие значения, чем у пациентов с трехстворчатым строением АК при сопоставимой площади отверстия.

Purpose

Purpose: comparison of hemodynamic parameters of transaortic blood flow in patients with aortic stenosis depending on the bivalve or tricuspid structure of the aortic valve.

Materials and methods

Materials and methods. A study of 180 patients with isolated aortic valve stenosis (AC) with two – and threeleaf structure was conducted. Patients were ranked into 3 comparison subgroups by the area of the effective AC opening from 4 to 1.5 cm2; 1.5 to 1 cm2 and less than 1 cm2. An echocardiographic study was performed with the calculation of all the necessary parameters for the study.

Results

Results. The comparison subgroups were comparable in terms of effective orifice area (AVA), effective orifice area index (IAVA), body mass index (BMI), LV UO index, and LV FV (p > 0.05). However, the indicators Vmax, Gmean, and AT in patients with a bivalve AK structure in all comparison subgroups were significantly higher than in patients with a tricuspid structure. Comparison subgroup with AVA from 4 to 1.5 cm2: Vmax 2.8 ± 9 m/s and 2.5 ± 6 m/s p = 0.02. Gmean 18.6 ± 7.2 mm Hg and 15 ± 6 mm Hg p = 0.03, AT 82 ± 12 ms and 70 ± 10 ms p = 0.002. Comparison subgroup with AVA from 1.5 to 1 cm2: Vmax 3.7 ± 0.8 m/s and 3.5 ± 0.6 m/s p = 0.02. Average transaortic gradient 37 ± 10 mm Hg and 29 ± 5 mm Hg p = 0.04, AT 103 ± 11 ms and 94 ± 10 ms p = 0.02. Comparison subgroup with an effective area of less than 1 cm2: Vmax 5.7 ± 1.2 m/s and 4.7 ± 0.7 m/s p = 0.001, Gmean 54 ± 15 and 43 ± 11 mm Hg p < 0.001, AT 127 ± 20 ms and 112 ± 10 ms p = 0.002.

Conclusion

Conclusion. Echocardiographic indicators of Vmax and Gmean in patients with bivalve AC structure have higher values than in patients with tricuspid AC structure with a comparable opening area.

аортальный стенозэхокардиографияплощадь отверстияградиент давленияaortic stenosisechocardiographyarea of the valvethe pressure gradientReferencesBaumgartner H., Hung J., Bermejo J., Chambers J.B., Edvardsen T., Goldstein S., Lancellotti P., LeFevre M., Miller F. Jr., Otto C.M., Recommendations on the echocardiographic assessment of aortic valve stenosis: a focused update from the european association of cardiovascular imaging and the american society of echocardiography J. Am. Soc. Echocardiogr. 2017; 30 (4): 372–392.Baumgartner H., Hung J., Bermejo J., Chambers J.B., Edvardsen T., Goldstein S., Lancellotti P., LeFevre M., Miller F. Jr., Otto C.M., Recommendations on the echocardiographic assessment of aortic valve stenosis: a focused update from the european association of cardiovascular imaging and the american society of echocardiography J. Am. Soc. Echocardiogr. 2017; 30 (4): 372–392.Lancellotti P., Donal E., Magne J., Moonen M., O'Connor K., Daubert J.C. Risk stratification in asymptomatic moderate to severe aortic stenosis: the importance of the valvular, arterial and ventricular interplay. Heart. 2010; 96: 1364–1371.Lancellotti P., Donal E., Magne J., Moonen M., O'Connor K., Daubert J.C. Risk stratification in asymptomatic moderate to severe aortic stenosis: the importance of the valvular, arterial and ventricular interplay. Heart. 2010; 96: 1364–1371.Vahanian A., Alfieri O., Andreotti F., Antunes M.J., Bar n- Esquivias G., Baumgartner H., Borger M.A., Carrel T.P., De Bonis M., Evangelista A., Falk V., Iung B., Lancellotti P., Pierard L., Price S., Schäfers H.J., Schuler G., Stepinska J., Swedberg K., Takkenberg J., Von Oppell U.O., Windecker S., Zamorano J.L., Zembala M. Guidelines on the management of valvular heart disease (version 2012). Eur. Heart J. 2012; 33 (19): 2451–2496. https://doi.org/10.1093/eurheartj/ehs109Vahanian A., Alfieri O., Andreotti F., Antunes M.J., Bar n- Esquivias G., Baumgartner H., Borger M.A., Carrel T.P., De Bonis M., Evangelista A., Falk V., Iung B., Lancellotti P., Pierard L., Price S., Schäfers H.J., Schuler G., Stepinska J., Swedberg K., Takkenberg J., Von Oppell U.O., Windecker S., Zamorano J.L., Zembala M. Guidelines on the management of valvular heart disease (version 2012). Eur. Heart J. 2012; 33 (19): 2451–2496. https://doi.org/10.1093/eurheartj/ehs109Nishimura R.A., Otto C.M., Bonow R.O., Carabello B.A., Erwin J.P. 3rd, Guyton R.A., O'Gara P.T., Ruiz C.E., Skubas N.J., Sorajja P., Sundt T.M. 3rd, Thomas J.D. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the american college of cardiology/ American heart association task force on practice guidelines. ACC/AHA Task Force Members. Circulation. 2014; 10: 2438–2488.Nishimura R.A., Otto C.M., Bonow R.O., Carabello B.A., Erwin J.P. 3rd, Guyton R.A., O'Gara P.T., Ruiz C.E., Skubas N.J., Sorajja P., Sundt T.M. 3rd, Thomas J.D. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the american college of cardiology/ American heart association task force on practice guidelines. ACC/AHA Task Force Members. Circulation. 2014; 10: 2438–2488.Baumgartner H., Hung J., Bermejo J., Chambers J.B., Edvardsen T, Goldstein S., Lancellotti P., LeFevre M., Miller F. Jr, Otto C.M. Recommendations on the echocardio graphic assessment of aortic valve stenosis: a focused update from the european association of cardiovascular imaging and the American Society of Echocardiography journal of the American Society of Echocardiography. J. Am. Soc. Echocardiogr. 2017; 30: 372–392. https://doi.org/10.1016/j.echo.2017.02.009.Baumgartner H., Hung J., Bermejo J., Chambers J.B., Edvardsen T, Goldstein S., Lancellotti P., LeFevre M., Miller F. Jr, Otto C.M. Recommendations on the echocardio graphic assessment of aortic valve stenosis: a focused update from the european association of cardiovascular imaging and the American Society of Echocardiography journal of the American Society of Echocardiography. J. Am. Soc. Echocardiogr. 2017; 30: 372–392. https://doi.org/10.1016/j.echo.2017.02.009.Minners J., Allgeier M., Gohlke-Baerwolf C., Kienzle R.P., Neumann F.J., Jander N. Inconsistent grading of aortic valve stenosis by current guidelines: haemodynamic studies in patients with apparently normal left ventricular function. Heart. 2010; 96: 1463–1468. https://doi.org/10.1136/hrt.2009.181982Minners J., Allgeier M., Gohlke-Baerwolf C., Kienzle R.P., Neumann F.J., Jander N. Inconsistent grading of aortic valve stenosis by current guidelines: haemodynamic studies in patients with apparently normal left ventricular function. Heart. 2010; 96: 1463–1468. https://doi.org/10.1136/hrt.2009.181982Minners J., Allgeier M., Gohlke-Baerwolf C., Kienzle R.P., Neumann F.J., Jander N. Inconsistencies of echo cardiographic criteria for the grading of aortic valve stenosis. Eur. Heart J. 2008; 29: 1043–1048.Minners J., Allgeier M., Gohlke-Baerwolf C., Kienzle R.P., Neumann F.J., Jander N. Inconsistencies of echo cardiographic criteria for the grading of aortic valve stenosis. Eur. Heart J. 2008; 29: 1043–1048.Jander N., Minners J., Holme I., Gerdts E., Boman K., Brudi P., Chambers J.B., Egstrup K., Kesäniemi Y.A, Malbecq W., Nienaber C.A., Ray S, Rossebø A., Pedersen T.R., Skjærpe T., Willenheimer R., Wachtell K., Neumann F.J., Gohlke-Bärwolf C. Outcome of patients with low-gradient “severe” aortic stenosis and preserved ejection fraction. Circulation. 2011; 123: 887–895.Jander N., Minners J., Holme I., Gerdts E., Boman K., Brudi P., Chambers J.B., Egstrup K., Kesäniemi Y.A, Malbecq W., Nienaber C.A., Ray S, Rossebø A., Pedersen T.R., Skjærpe T., Willenheimer R., Wachtell K., Neumann F.J., Gohlke-Bärwolf C. Outcome of patients with low-gradient “severe” aortic stenosis and preserved ejection fraction. Circulation. 2011; 123: 887–895.Michelena H.I., Margaryan E., Miller F.A., Eleid M., Maalouf J., Suri R., Messika-Zeitoun D., Pellikka P.A., Enriquez-Sarano M. Inconsistent echocardiographic grading of aortic stenosis: is the left ventricular outflow tract important? Heart. 2013; 99: 921–931.Michelena H.I., Margaryan E., Miller F.A., Eleid M., Maalouf J., Suri R., Messika-Zeitoun D., Pellikka P.A., Enriquez-Sarano M. Inconsistent echocardiographic grading of aortic stenosis: is the left ventricular outflow tract important? Heart. 2013; 99: 921–931.Hachicha Z., Dumesnil J.G., Bogaty P., Pibarot P. Paradoxical low flow, low gradient severe aortic stenosis despite preserved ejection fraction is associated with higher afterload and reduced survival. Circulation. 2007; 115: 2856–2864.Hachicha Z., Dumesnil J.G., Bogaty P., Pibarot P. Paradoxical low flow, low gradient severe aortic stenosis despite preserved ejection fraction is associated with higher afterload and reduced survival. Circulation. 2007; 115: 2856–2864.Ozkan A. Low gradient “severe” aortic stenosis with preserved left ventricular ejection fraction. Cardiovasc. Diagn. Ther. 2012; 2: 19–27.Ozkan A. Low gradient “severe” aortic stenosis with preserved left ventricular ejection fraction. Cardiovasc. Diagn. Ther. 2012; 2: 19–27.Pibarot P., Dumesnil J.G. Low-flow, low-gradient aortic stenosis with normal and depressed left ventricular ejection fraction. J. Am. Coll. Cardiol. 2012; 60: 1845–1853.Pibarot P., Dumesnil J.G. Low-flow, low-gradient aortic stenosis with normal and depressed left ventricular ejection fraction. J. Am. Coll. Cardiol. 2012; 60: 1845–1853.Adda J., Mielot C., Giorgi R., Cransac F., Zirphile X., Donal E., Sportouch-Dukhan C., Réant P., Laffitte S., Cade S., Le Dolley Y., Thuny F., Touboul N., Lavoute C., Avierinos J.F., Lancellotti P., Habib G. Low-flow, lowgradient severe aortic stenosis despite normal ejection fraction is associated with severe left ventricular dysfunction as assessed by speckle-tracking echocardiography: A multicenter study. Circ. Cardiovasc. Imaging. 2012; 5: 27–35.Adda J., Mielot C., Giorgi R., Cransac F., Zirphile X., Donal E., Sportouch-Dukhan C., Réant P., Laffitte S., Cade S., Le Dolley Y., Thuny F., Touboul N., Lavoute C., Avierinos J.F., Lancellotti P., Habib G. Low-flow, lowgradient severe aortic stenosis despite normal ejection fraction is associated with severe left ventricular dysfunction as assessed by speckle-tracking echocardiography: A multicenter study. Circ. Cardiovasc. Imaging. 2012; 5: 27–35.Eleid M.F., Sorajja P., Michelena H.I., Malouf J.F., Scott C.G., Pellikka P.A. Flow-gradient patterns in severe aortic stenosis with preserved ejection fraction: clinical characteristics and predictors of survival. Circulation. 2013; 128: 1781–1789.Eleid M.F., Sorajja P., Michelena H.I., Malouf J.F., Scott C.G., Pellikka P.A. Flow-gradient patterns in severe aortic stenosis with preserved ejection fraction: clinical characteristics and predictors of survival. Circulation. 2013; 128: 1781–1789.Lancellotti P., Magne J., Donal E., Davin L., O'Connor K., Rosca M., Szymanski C., Cosyns B., Piérard L.A. Clinical outcome in asymptomatic severe aortic stenosis insights from the new proposed aortic stenosis grading classification. J. Am. Coll. Cardiol. 2012; 59: 235–243.Lancellotti P., Magne J., Donal E., Davin L., O'Connor K., Rosca M., Szymanski C., Cosyns B., Piérard L.A. Clinical outcome in asymptomatic severe aortic stenosis insights from the new proposed aortic stenosis grading classification. J. Am. Coll. Cardiol. 2012; 59: 235–243.Saito T., Muro T., Takeda H., Hyodo E., Ehara S., Nakamura Y., Hanatani A., Shimada K., Yoshiyama M. Prognostic value of aortic valve area index in asymptomatic patients with severe aortic stenosis. Am. J. Cardiol. 2012; 110: 93–97.Saito T., Muro T., Takeda H., Hyodo E., Ehara S., Nakamura Y., Hanatani A., Shimada K., Yoshiyama M. Prognostic value of aortic valve area index in asymptomatic patients with severe aortic stenosis. Am. J. Cardiol. 2012; 110: 93–97.Jander N., Gohlke-Bärwolf C., Bahlmann E., Gerdts E., Boman K., Chambers J.B., Egstrup K., Nienaber C.A., Pedersen T.R., Ray S., Rossebø A.B., Willenheimer R., Kienzle R.P., Wachtell K., Neumann F.J., Minners J. Indexing aortic valve area by body surface area increases the prevalence of severe aortic stenosis. Heart. 2014; 100: 28–33.Jander N., Gohlke-Bärwolf C., Bahlmann E., Gerdts E., Boman K., Chambers J.B., Egstrup K., Nienaber C.A., Pedersen T.R., Ray S., Rossebø A.B., Willenheimer R., Kienzle R.P., Wachtell K., Neumann F.J., Minners J. Indexing aortic valve area by body surface area increases the prevalence of severe aortic stenosis. Heart. 2014; 100: 28–33.Jander N., Gohlke-Bärwolf C., Bahlmann E., Gerdts E., Boman K., Chambers J.B., Egstrup K., Nienaber C.A., Pedersen T.R., Ray S., Rossebø A.B., Willenheimer R., Kienzle R.P., Wachtell K., Neumann F.J., Minners J. Adjusting parameters of aortic valve stenosis severity by body size. Heart. 2014; 100: 1024–1030.Jander N., Gohlke-Bärwolf C., Bahlmann E., Gerdts E., Boman K., Chambers J.B., Egstrup K., Nienaber C.A., Pedersen T.R., Ray S., Rossebø A.B., Willenheimer R., Kienzle R.P., Wachtell K., Neumann F.J., Minners J. Adjusting parameters of aortic valve stenosis severity by body size. Heart. 2014; 100: 1024–1030.Zoghbi W.A., Enriquez-Sarano M., Foster E., Grayburn P.A., Kraft C.D., Levine R.A., Nihoyannopoulos P., Otto C.M., Quinones M.A., Rakowski H., Stewart W.J., Waggoner A., Weissman N.J. Recommendations for evaluation of the severity of native valvular regurgitation with twodimensional and Doppler echocardiography. J. Am. Soc. Echocardiogr. 2003; 16: 777–802.Zoghbi W.A., Enriquez-Sarano M., Foster E., Grayburn P.A., Kraft C.D., Levine R.A., Nihoyannopoulos P., Otto C.M., Quinones M.A., Rakowski H., Stewart W.J., Waggoner A., Weissman N.J. Recommendations for evaluation of the severity of native valvular regurgitation with twodimensional and Doppler echocardiography. J. Am. Soc. Echocardiogr. 2003; 16: 777–802.Baumgartner H., Stefenelli T., Niederberger J., Schima H., Maurer G. ‘Overestimation’of catheter gradients by Doppler ultrasound in patients with aortic stenosis: a predictable manifestation of pressure recovery. J. Am. Coll. Cardiol. 1999; 33: 1655–1661.Baumgartner H., Stefenelli T., Niederberger J., Schima H., Maurer G. ‘Overestimation’of catheter gradients by Doppler ultrasound in patients with aortic stenosis: a predictable manifestation of pressure recovery. J. Am. Coll. Cardiol. 1999; 33: 1655–1661.Mascherbauer J., Fuchs C., Stoiber M., Schima H., Pernicka E., Maurer G. Systemic pressure does not directly affect pressure gradient and valve area estimates in aortic stenosis in vitro. Eur. Heart J. 2008; 29: 2049–2057.Mascherbauer J., Fuchs C., Stoiber M., Schima H., Pernicka E., Maurer G. Systemic pressure does not directly affect pressure gradient and valve area estimates in aortic stenosis in vitro. Eur. Heart J. 2008; 29: 2049–2057.

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