Abstract

Purpose. Echocardiography assessment from apical five-chamber view (A5CV) is the standard technique for aortic stenosis (AS) grading. Data on non-apical views, such as right parasternal (RPV), subcostal (SCV) and suprasternal notch (SSNV), is scarce and constitutes the aim of our study. Methods. We designed an observational study that included patients with AS recruited prospectively in whom the stenosis was graded by echocardiography from A5CV and non-apical view. The value of non-apical views in up-grading the stenosis severity (primary objective), the prognostic relevance of such reclassification and the feasibility and reproducibility of non-apical views assessment (secondary objectives) was evaluated. Results. Feasibility of AS appraisal from RPV, SCV and SSNV was 78%, 81% and 56%, respectively (SCV vs SSNV, p = .009). AS were up-graded from non-apical views according to peak gradient, mean gradient, area and indexed area by 24%, 17%, 24% and 22%, respectively (p < .0001). Non-apical views reclassified from non-severe to severe AS, from low gradient severe to high gradient severe AS and from non-critical to critical AS 19%, 23% and 3% of cases (p < .0001). The 4-years hard cardiac events rate was 41% in patients with non-severe AS, 67% in patients with severe AS from non-apical views, 68% in patients with severe AS from A5CV and 80% in patients with severe AS from A5CV and non-apical views (p < .001). Reproducibility of AS evaluation from non-apical views was fair to excellent (intraclass correlation coefficients: SSNV = 0.44, RPV = 0.61, SCV = 0.92). Conclusion. Assessment of AS from non-apical views is feasible, reproducible and valuable over A5CV; its use is encouraged.

摘要

目的。心尖五腔切面 (A5CV) 超声心动图评估是主动脉瓣狭窄 (AS) 分级的标准技术。非心尖切面的数据，如右胸骨旁 (RPV)、肋下 (SCV) 和胸骨上切迹 (SSNV) 是稀缺的，构成了我们研究的目的。方法。我们设计了一项观察性研究，纳入前瞻性招募的 AS 患者，其中狭窄通过超声心动图从 A5CV 和非心尖视图分级。评估了非心尖视图在升级狭窄严重程度（主要目标）中的价值、这种重新分类的预后相关性以及非心尖视图评估的可行性和可重复性（次要目标）。结果。从 RPV、SCV 和 SSNV 进行 AS 评估的可行性分别为 78%、81% 和 56%（SCV 与 SSNV，p  = .009 ）。根据峰梯度、平均梯度、面积和索引面积，AS 从非根尖视图分别升级了 24%、17%、24% 和 22% ( p  < .0001)。19%、23% 和 3% 的病例（p  < .0001）将非心尖切面从非严重到严重 AS、从低梯度严重到高梯度严重 AS 以及从非严重到严重 AS 重新分类。非严重 AS 患者的 4 年硬性心脏事件发生率为 41%，非心尖切面的严重 AS 患者为 67%，A5CV 导致的严重 AS 患者为 68%，A5CV 导致的严重 AS 患者为 80%。 A5CV 和非心尖视图 ( p < .001）。从非心尖切面评估 AS 的可重复性从一般到优秀（组内相关系数：SSNV = 0.44，RPV = 0.61，SCV = 0.92）。结论。与 A5CV 相比，从非心尖角度评估 AS 是可行的、可重复的和有价值的；鼓励使用它。