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Mat ósæðarlokuþrengsla með Dopplerómun

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Authors
Ragnar Danielsen
Nordrehaug, Jan Erik
Vik-Mo, Harald
Issue Date
1988-11-15

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Læknablaðið 1988, 74(9):379-84
Abstract
Continuous-wave Doppler echocardiography was performed in 30 consequtive adult patients (18 males) with suspected aortic stenosis (AS) within 48 hours prior to cardiac catheterisation. The mean age was 63 ± 10 years (range 33-75 years); 28 (93%) of the patients were >50 years. The maximal Doppler and catheterisation gradients were similar and correlated closely (r = 0.96). Both these maximal gradients were different from, and significantly higher than the traditional peak-to-peak gradients at catheterisation (p< 0.001). The mean Doppler and catheterisation gradients showed a close correlation (r = 0.93), but the mean Doppler gradients were on the average slightly lower than the mean catheterisation gradients (Y = 1.03X-6.1, p< 0.001). A curvilinear regression function described the relationship of both the maximal and the mean Doppler gradients to the aortic valve area (AVA) indexes (cmVm2) at catheterisation (r = 0.80 and r = 0.78, respectively). Thus, significant AS, defined as an AVA index of <0.5 cmVm2, was usually represented by maximal and mean Doppler gradients of > 54 and > 33 mmHg, respectively. However, a considerable range of Doppler gradients corresponded to a given AVA index, illustrating the importance of also considering the influence of transvalvular aortic flow, when assessing the severity of AS.
Síbylgju Doppler-ómun var gerð hjá 30 sjúklingum (18 körlum) er grunaðir voru um ósæðarlokuþrengsli. Rannsóknin var gerð skemur en 48 klukkustundum fyrir hjartaþræðingu. Sjúklingarnir voru á aldrinum 33 til 75 ára (meðalaldur 63 ± 10 ár) og 28 þeirra (93%) voru 50 ára eða eldri. Mat á hámarksþrýstingsfalli yfir ósæðarlokuþrengslin var álíka með Doppler-ómun og við hjartaþræðingu (r = 0,96). Hámarks þrýstingsfall metið með báðum aðferðum var ólíkt og marktækt hærra (p< 0,001) en hið hefðbundna frá toppi til topps þrýstingsfall (peak-to-peak) við hjartaþræðingu. Góð fylgni fannst milli meðal Dopplerþrýstingsfalla og meðal þrýstingsfalla við hjartaþræðingu (r = 0,93), en þau fyrri voru að jafnaði nokkru lægri en þau síðari (Y= 1,03X-6,1, p< 0,001). Kúrfulínuleg liking lýsti tengslum hámarks og meðal Doppler þrýstingsfalla við leiðrétt ósæðarlokuflatarmál (aortic valve area index, cmVm2), er ákvörðuð voru við hjartaþræðingu (r = 0,80 annarsvegar og r = 0,78 hinsvegar). Marktsek ósæðarlokuþrengsli, skilgreind sem leiðrétt ósæðarlokuflatarmál <0,5 cmVm2, samsvöruðu oftast hámarks og meðal Doppler þrýstingsföllum >54 ramHg annarsvegar og >33 mmHg hinsvegar. Aftur á móti var mikil dreifing á þeim Doppler þrýstingsföllum er fundust við ákveðið leiðrétt ósæðarlokuflatarmál. Samkvæmt líkingu Gorlins stafar þetta af mismunandi ósæðarlokuflæði. Þótt gott samræmi sé milli Doppler og hjartaþræðingar þrýstingsfalla, undirstrikar þetta mikilvægi þess að taka einnig tillit til breytileika í ósæðarlokuflæði milli einstaklinga þegar metið er hversu alvarleg ósæðarlokuþrengsli eru.
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