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Актуальность использования правой парастернальной проекции в эхокардиографической оценке тяжести аортального стеноза. Результаты одноцентрового исследования

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Цель исследования: оценить эффективность использования правой парастернальной проекции (ППП) в дополнение к апикальной пятикамерной проекции (А5КП) для оценки тяжести аортального стеноза (АС); определить факторы, влияющие на согласованность оценки тяжести АС в ППП и А5КП.Материал и методы. В период набора пациентов было последовательно исследовано 232 пациента, в окончательный анализ было включено 186 (80%) пациентов с доступной ППП.Критерии включения: пациенты с АС (сочетание кальцинированного аортального клапана и максимальной трансаортальной скорости более 2,5 м/с) и доступной ППП для оценки тяжести АС.Результаты. Средние показатели Gmax и Gmean, оцененные в ППП, были достоверно выше, а средние значения площади аортального клапана (AVA) и безразмерного индекса (DVI) были ниже по сравнению с аналогичными показателями, оцененными в А5КП (р <0,05). При анализе методом Бленда–Альтмана средняя разница Gmax и Gmean, оцененная в А5КП и ППП, составила 10,2 ± 14,3 и 4,5 ± 8,9 мм рт.ст. соответственно. Средняя разница AVA и DVI, оцененная в А5КП и ППП, составила 0,1 ± 0,15 см2 и 0,02 ± 0,03 соответственно. При использовании ППП у 44 (23%) пациентов удалось реклассифицировать тяжесть АС на более тяжелую степень. Анализ множественной логистической регрессии выявил, что аортосептальный угол является единственным независимым параметром, оказывающим значимое влияние на согласованность в оценке тяжести АС между двумя акустическими проекциями (OШ 0,76; 95% ДИ 0,69–0,83; p < 0,001).Выводы. 1. Использование А5КП в значительном проценте случаев может привести к недооценке тяжести АС. Оценка тяжести АС в ППП в дополнение к А5КП может значительно увеличить диагностическую точность эхокардиографического исследования.2. Аортосептальный угол является независимым фактором, значимо влияющим на согласованность в оценке тяжести АС между двумя проекциями.

Ключевые слова:
: аортальный стеноз, правая парастернальная проекция, апикальная пятикамерная проекция, реклассификация, эхокардиография, aortic stenosis, right parasternal view, apical five-chamber view, reclassification, echocardiography

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Relevance of using the right parasternal projection in ultrasound assessing the severity of aortic stenosis. Results of a single-center prospective study

Objective. To evaluate the effectiveness of using the right parasternal view (RPV) in addition to the apical five-chamber view (A5CV) for assessing the severity of aortic stenosis (AS) and to identify factors influencing the concordance of AS severity assessment between RPV and A5CV.Materials and Methods. During the patient recruitment period, 232 patients were consecutively examined, and 186 (80%) patients with an available RPV were included in the final analysis.Inclusion criteria: Patients with AS (combination of a calcified aortic valve and a peak transaortic velocity >2.5 m/s) and an available RPV for AS severity assessment.Results. The average Gmax and Gmean values assessed in RPV were significantly higher, and the average AVA and DVI values were lower compared to similar values assessed in the A5СV, p <0.05. Bland-Altman analysis showed that the mean differences in Gmax and Gmean between A5CV and RPV were 10.2±14.3 mmHg and 4.5±8.9 mmHg, respectively. The mean differences in AVA and DVI between A5CV and RPV were 0.1±0.15 cm2 and 0.02±0.03 ml, respectively. Using RPV allowed reclassification of AS severity to a more severe degree of aortic stenosis in 44 (23%) patients. Multivariate logistic regression analysis identified the aorto-septal angle as the only independent parameter significantly affecting the concordance of AS severity assessment between the two acoustic projections (OR 0.76; 95% CI 0.69-0.83, p <0.001).Conclusion. 1. The use of A5CV alone may lead to an underestimation of AS severity in a significant proportion of cases. Assessing the severity of aortic stenosis in the RPV in addition to the A5СV can significantly increase the diagnostic accuracy of echocardiography.2.The aorto-septal angle is an independent factor significantly influencing the concordance of AS severity assessment between the two echocardiographic views.

Keywords:
: аортальный стеноз, правая парастернальная проекция, апикальная пятикамерная проекция, реклассификация, эхокардиография, aortic stenosis, right parasternal view, apical five-chamber view, reclassification, echocardiography