摘要
目的评估经胸超声心动图(TTE)在经导管主动脉瓣置换术(TAVR)术后人工瓣膜血栓中的诊断价值。方法收集2015年6月至2019年6月于中国医学科学院阜外医院成功实施TAVR的80例患者术前、术后及随访期TTE数据和CT数据进行回顾分析。与CT诊断TAVR瓣膜血栓进行对比,分析TTE在形态学及血流动力学方面评估TAVR瓣膜血栓的价值。结果随访的80例患者中,CT诊断TAVR瓣膜血栓36例(45.00%)。患者随访时峰值流速(Vmax)、峰值跨瓣压差(PPG)、平均跨瓣压差(MPG)及有效瓣口面积(AVA)与出院前比较,差异均无统计学意义(均P>0.05)。血栓组与正常组Vmax、PPG、MPG、ΔVmax、ΔPPG、ΔMPG及ΔVmax%、ΔPPG%、ΔMPG%比较,差异均无统计学意义(均P>0.05),但是AVA[(1.47±0.29)cm^(2)比(1.71±0.45)cm^(2),P=0.006]、ΔAVA[(-0.15±0.35)cm^(2)比(0.07±0.44)cm^(2),P=0.018]及ΔAVA%[(-7.10±18.73)%比(8.61±31.12)%,P=0.007]的差异均有统计学意义。CT血栓负荷低分组18例(50.0%),中间组14例(38.9%),高分组4例(11.1%)。CT血栓负荷高分组与低分组、中间组PPG[(39.15±17.49)mmHg比(17.73±7.21)mmHg比(26.04±12.93)mmHg,P=0.003]、ΔVmax%[(25.01±33.18)%比(-6.52±17.47)%比(3.35±24.30)%,P=0.040]、ΔAVA%[(-30.54±17.10)%比(-4.97±14.87)%比(-3.32±19.95)%,P=0.020]的差异均有统计学意义,而低分组与中间组比较,差异均无统计学意义(均P>0.05)。AVA绝对变化值曲线下面积0.615(P=0.078),以ΔAVA>0.28 cm^(2)预测TAVR瓣膜血栓的特异度为75.0%,敏感度为25.0%。ΔAVA%的曲线下面积为0.638(P=0.035),以ΔAVA%>15.4%预测TAVR瓣膜血栓的特异度为77.3%,敏感度为27.8%。所有患者TTE检查均未发现TAVR瓣叶增厚及血栓附着,仅CT血栓负荷高分组2例患者TTE显示瓣架内血流加速、Vmax及MPG明显增高而提示血栓可能。结论TAVR术后瓣膜血栓的血流动力学改变以静默为主,AVA的变化可以为血栓形成评估提供参考,但可靠性较差。
Objective To evaluate the value of transthoracic echocardiography(TTE)in the diagnosis of prosthetic valve thrombus after transcatheter aortic valve replacement(TAVR).Methods The data of TTE and CT at pre-TAVR,hospital discharge and follow-up of eighty patients who underwent successful TAVR from June 2015 to June 2019 in Fuwai hospital were collected.The value of TTE in morphological and hemodynamic evaluation of TAVR valve thrombus is retrospective analysis compared to the follow-up CT.Results Among the 80 patients,36 cases(45.00%)were diagnosed with thrombus by CT.There was no signifi cant diff erence(all P>0.05)in Vmax,peak pressure gradient(PPG),mean pressure gradient(MPG)and available aortic valve area(AVA)between the follow-up and before hospital discharge.The Vmax,PPG,MPG,ΔVmax,ΔPPG,ΔMPG,ΔVmax%,ΔPPG%orΔMPG%had no statistical diff erence(all P>0.05)between thrombus group and normal group,but there were significant differences in AVA[(1.47±0.29)cm^(2) vs.(1.71±0.45)cm^(2),P=0.006],ΔAVA[(–0.15±0.35)cm^(2) vs.(0.07±0.44)cm^(2),P=0.018]andΔAVA%[(–7.10±18.73)%vs.(8.61±31.12)%,P=0.007].There were 18 cases(50.0%)of low thrombus loads,14 cases(38.9%)of intermediate thrombus loads and 4 cases(11.1%)of high thrombus loads.There were significant differences in PPG[(39.15±17.49)mm Hg vs.(17.73±7.21)mm Hg vs.(26.04±12.93)mm Hg,P=0.003]、ΔVmax%[(25.01±33.18)%vs.(–6.52±17.47)%vs.(3.35±24.30)%,P=0.040]、ΔAVA%[(–30.54±17.10)%vs.(–4.97±14.87)%vs.(–3.32±19.95)%,P=0.020]between the high and low thrombus load groups and the intermediate group,but there was no signifi cant diff erences between the low and intermediate groups(all P>0.05).The specifi city and sensitivity were 75.0%and 25.0%in diagnosis thrombus in TAVR valve withΔAVA>0.28 cm^(2),the area under the curve is 0.615(P=0.078).The specifi city and sensitivity were 77.3%and 27.8%withΔAVA%greater than 15.4%,the area under the curve is 0.638(P=0.035).TTE showed that there was no thickening of TAVR leafl et and thrombus attachment in all patients.Only two patients with high thrombus load showed limited movement of biological leafl et and signifi cantly increased mean pressure diff erence,which suggested the possibility of thrombus.Conclusions The hemodynamic changes of valve thrombus after TAVR are mainly silent.The changes of eff ective valve area can provide reference for the evaluation of thrombosis,but the reliability is poor.
作者
王建德
任心爽
王婧金
梁玉
逄坤静
王浩
牛冠男
王墨杨
吴永健
吕滨
WANG Jian-de;REN Xin-shuang;WANG Jing-jin;LIANG Yu;PANG Kun-jing;WANG Hao;NIU Guan-nan;WANG Mo-yang;WU Yong-jian;LV Bin(Ultrasound Imaging Center,National Center for Cardiovascular Diseases,Fuwai Hospitial,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China)
出处
《中国介入心脏病学杂志》
2022年第5期342-347,共6页
Chinese Journal of Interventional Cardiology
关键词
血栓
经胸超声心动图
经导管主动脉瓣置换术
Thrombus
Transthoracic echocardiography
Transcatheter aortic valve replacement
