The 2016 guidelines of the American Society of Echocardiography (ASE) and European Association of Cardiovascular Imaging (EACVI) for evaluation of left ventricular (LV) diastolic dysfunction by Doppler flow and tissue Doppler- echocardiography do not adjust assessment of high filling pressures for patients with aortic stenosis (AS). However, most of the studies on this patient group indicate age independent specific diastolic features in AS. The aim of this study is to identify disease-specific range and distribution of diastolic functional parameters and their ability to identify high N-terminal prohormone of brain natriuretic peptide (NT-proBNP) levels as a marker for high filling pressures. In this study, 169 patients who underwent surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR) were prospectively enrolled. Resting echocardiography was performed including Doppler of the mitral inflow, pulmonary venous flow, tricuspid regurgitant flow and tissue Doppler in the mitral ring and indexed volume-estimates of the left atrium (LAVI). Echocardiography, and NT-proBNP levels were assessed before TAVR/SAVR and at two postoperative visits at 6 and 12 months. Pre- and postoperative values were septal e′; 5.1 ± 3.9, 5.2 ± 1.6 cm/s; lateral e′ 6.3 ± 2.1; 7.7 ± 2.7 cm/s; E/e′19 ± 8; 16 ± 7 cm/s; E velocity 96 ± 32; 95 ± 32 cm/s; LAVI 39 ± 8; 36 ± 8 ml/m2, pulmonary artery pressure (PAP) 39 ± 8; 36 ± 8 mmHg, respectively. The scoring recommended by ASE/EACVI detected elevated NT pro-BNP with a specificity of 25%. Adjusting thresholds towards PAP ≥ 40 mmHg, E velocity ≥ 100 cm/s, E deceleration time < 220 ms, and E/septal e′ ≥ 20 or septal e′ < 5.0 cm/s increased prediction of NT-proBNP levels ≥500 ng/L with substantially improved specificity (> 85%). Diastolic echocardiographic parameters in AS indicate persistent impaired relaxation and NT-proBNP indicate elevated filling pressures in most of the patients, improving only modestly 6–12 months after TAVR and SAVR. Applying the 2016 ASE/EACVI recommendations for detection of elevated filling pressures to patients with AS, elevated NT pro-BNP levels could not be reliably detected. However, adjusting thresholds of the echocardiographic parameters increased specificities to useful diagnostic levels. The study was prospectively approved by the regional ethical committee, REK North with the registration number: REK 2010/397-10 .

中文翻译：

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老年重度主动脉瓣狭窄患者主动脉瓣置换术前后舒张功能障碍的超声心动图评估

美国超声心动图学会 (ASE) 和欧洲心血管成像协会 (EACVI) 2016 年通过多普勒血流和组织多普勒-超声心动图评估左心室 (LV) 舒张功能障碍的指南没有调整对高充盈压的评估主动脉瓣狭窄 (AS)。然而，大多数关于该患者组的研究表明 AS 的特定舒张特征与年龄无关。本研究的目的是确定疾病特异性范围和舒张功能参数的分布及其识别高 N 端脑钠肽原 (NT-proBNP) 水平作为高充盈压标志物的能力。在这项研究中，169 名接受外科主动脉瓣置换术 (SAVR) 或经导管主动脉瓣置换术 (TAVR) 的患者被前瞻性纳入。进行静息超声心动图检查，包括二尖瓣流入多普勒、肺静脉血流、三尖瓣反流血流和二尖瓣环组织多普勒以及左心房 (LAVI) 的索引容积估计。超声心动图和 NT-proBNP 水平在 TAVR/SAVR 之前和术后 6 个月和 12 个月的两次随访中进行评估。术前和术后值是间隔 e'；5.1 ± 3.9、5.2 ± 1.6 厘米/秒；横向e′ 6.3 ± 2.1；7.7 ± 2.7 厘米/秒；E/e′19±8；16 ± 7 厘米/秒；E 速度 96±32；95 ± 32 厘米/秒；LAVI 39±8；36±8ml/m2，肺动脉压（PAP）39±8；分别为 36 ± 8 mmHg。ASE/EACVI 推荐的评分检测到 NT pro-BNP 升高，特异性为 25%。将阈值调整为 PAP ≥ 40 mmHg、E 速度 ≥ 100 cm/s、E 减速时间 < 220 ms 和 E/septal e' ≥ 20 或 septal e' < 5.0 cm/s 增加对 NT-proBNP 水平的预测 ≥500 ng /L 具有显着提高的特异性 (> 85%)。AS 中的舒张超声心动图参数表明持续性松弛受损，NT-proBNP 表明大多数患者的充盈压升高，在 TAVR 和 SAVR 后 6-12 个月仅略有改善。将 2016 年 ASE/EACVI 建议用于检测 AS 患者的充盈压升高，无法可靠地检测到 NT pro-BNP 水平升高。然而，调整超声心动图参数的阈值将特异性提高到有用的诊断水平。该研究获得了区域伦理委员会的前瞻性批准，