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Abstract：
BACKGROUND: The development of heart failure is a turning point in the natural course of aortic stenosis (AS). Pulmonary oedema and elevated left ventricular pressure (LVP) are cardinal features of heart failure. Evaluating pulmonary oedema by lung ultrasound involves taking the upper hand with a bedside noninvasive tool that may reflect LVP.
OBJECTIVE: We sought to assess the correlation between sonographic pulmonary congestion, invasive LV pre-A pressure, and echocardiographic LV end-diastolic pressure (LVEDP) in symptomatic AS patients receiving transcatheter aortic valve replacement.
METHODS: Forty-eight consecutive patients with severe AS and planned transcatheter aortic valve implantation (TAVI) were enrolled. LVEDP was estimated to be normal or elevated using the ASE/EACVI algorithm and transmitral Doppler indices, the E/A ratio, the E/e\', and the left atrial volume index. Invasive LV pre-A pressure was used as a reference, with > 12 mm Hg defined as elevated.
RESULTS: Forty-eight patients (25 women (52%), mean age 75 years, standard deviation (SD) ± 7.7 years) were enrolled in the study. We detected severe B-lines (≥ 30) in 13 (27%) patients and moderate B-lines (15-30) in 33 (68.6%) patients. The number of B-lines increased significantly with the severity of New York Heart Association (NYHA) functional classes (Fig. 1). The B-line count was 14 ± 13 in NYHA class I patients, 20 ± 20 in class II patients, and 44 ± 35 in class III patients (p < 0.05, rho = 0.384). The number of B-lines was correlated with the E/E\' ratio (R = 0.664, p < 0.0001) and the proBNP level (R = 0. 882, p < 0.008). We found no significant correlation with the LVEDP or LVEF. The LVEDP correlated well with the E/E\' ratio (R = 0.491, p < 0.001) but not at all with E/A, DT, or LAVI. All patients had an elevated LVEDP > 12, with a mean pressure of 26 mmHg, a minimum of 13 mmHg, and a maximum of 45 mmHg, with an SD of 7.85.
CONCLUSIONS: Assessing lung ultrasonic B-lines is a straightforward and practical approach to identifying pulmonary oedema in AS patients. The number of B-lines correlated with the E/E\' ratio and the functional status of patients but did not correlate with invasive LVEDP or LVEF. All patients had elevated LVEDP that correlated with E/E\'.
OBJECTIVE: We sought to assess the correlation between sonographic pulmonary congestion, invasive LV pre-A pressure, and echocardiographic LV end-diastolic pressure (LVEDP) in symptomatic AS patients receiving transcatheter aortic valve replacement.
METHODS: Forty-eight consecutive patients with severe AS and planned transcatheter aortic valve implantation (TAVI) were enrolled. LVEDP was estimated to be normal or elevated using the ASE/EACVI algorithm and transmitral Doppler indices, the E/A ratio, the E/e\', and the left atrial volume index. Invasive LV pre-A pressure was used as a reference, with > 12 mm Hg defined as elevated.
RESULTS: Forty-eight patients (25 women (52%), mean age 75 years, standard deviation (SD) ± 7.7 years) were enrolled in the study. We detected severe B-lines (≥ 30) in 13 (27%) patients and moderate B-lines (15-30) in 33 (68.6%) patients. The number of B-lines increased significantly with the severity of New York Heart Association (NYHA) functional classes (Fig. 1). The B-line count was 14 ± 13 in NYHA class I patients, 20 ± 20 in class II patients, and 44 ± 35 in class III patients (p < 0.05, rho = 0.384). The number of B-lines was correlated with the E/E\' ratio (R = 0.664, p < 0.0001) and the proBNP level (R = 0. 882, p < 0.008). We found no significant correlation with the LVEDP or LVEF. The LVEDP correlated well with the E/E\' ratio (R = 0.491, p < 0.001) but not at all with E/A, DT, or LAVI. All patients had an elevated LVEDP > 12, with a mean pressure of 26 mmHg, a minimum of 13 mmHg, and a maximum of 45 mmHg, with an SD of 7.85.
CONCLUSIONS: Assessing lung ultrasonic B-lines is a straightforward and practical approach to identifying pulmonary oedema in AS patients. The number of B-lines correlated with the E/E\' ratio and the functional status of patients but did not correlate with invasive LVEDP or LVEF. All patients had elevated LVEDP that correlated with E/E\'.
摘要：
背景：心力衰竭的发展是主动脉瓣狭窄（AS）自然过程中的转折点。肺水肿和左心室压力（LVP）升高是心力衰竭的主要特征。通过肺部超声评估肺水肿涉及使用可能反映LVP的床边无创工具占上风。
目的：我们试图评估超声检查肺充血，有创左心室A前压力，接受经导管主动脉瓣置换术的有症状AS患者的超声心动图LV舒张末期压（LVEDP）。
方法：纳入48例连续的重度AS和计划的经导管主动脉瓣植入术（TAVI）患者。使用ASE/EACVI算法和透射多普勒指数估计LVEDP正常或升高。E/A比，E/E\'，和左心房容积指数。使用有创左心室A前压力作为参考，>12mmHg定义为升高。
结果：48名患者（25名女性（52％），平均年龄75岁,标准差(SD)±7.7年)纳入研究.我们在13例（27％）患者中检测到重度B线（≥30），在33例（68.6％）患者中检测到中度B线（15-30）。随着纽约心脏协会（NYHA）功能等级的严重程度，B线的数量显着增加（图。1).NYHAI级患者的B线计数为14±13，II类患者20±20，III类患者为44±35（p<0.05，rho=0.384）。B线的数量与E/E比值（R=0.664，p<0.0001）和proBNP水平（R=0）相关。882，p<0.008）。我们发现与LVEDP或LVEF没有显着相关性。LVEDP与E/E比值（R=0.491，p<0.001）相关良好，但与E/A完全无关，DT,或者LAVI.所有患者的LVEDP升高>12，平均压力为26mmHg，最低13mmHg，最高45mmHg,SD为7.85。
结论：评估肺部超声B线是确定AS患者肺水肿的一种简单而实用的方法。B线的数量与E/E比值和患者的功能状态相关，但与侵入性LVEDP或LVEF无关。所有患者的LVEDP升高与E/E'相关。
目的：我们试图评估超声检查肺充血，有创左心室A前压力，接受经导管主动脉瓣置换术的有症状AS患者的超声心动图LV舒张末期压（LVEDP）。
方法：纳入48例连续的重度AS和计划的经导管主动脉瓣植入术（TAVI）患者。使用ASE/EACVI算法和透射多普勒指数估计LVEDP正常或升高。E/A比，E/E\'，和左心房容积指数。使用有创左心室A前压力作为参考，>12mmHg定义为升高。
结果：48名患者（25名女性（52％），平均年龄75岁,标准差(SD)±7.7年)纳入研究.我们在13例（27％）患者中检测到重度B线（≥30），在33例（68.6％）患者中检测到中度B线（15-30）。随着纽约心脏协会（NYHA）功能等级的严重程度，B线的数量显着增加（图。1).NYHAI级患者的B线计数为14±13，II类患者20±20，III类患者为44±35（p<0.05，rho=0.384）。B线的数量与E/E比值（R=0.664，p<0.0001）和proBNP水平（R=0）相关。882，p<0.008）。我们发现与LVEDP或LVEF没有显着相关性。LVEDP与E/E比值（R=0.491，p<0.001）相关良好，但与E/A完全无关，DT,或者LAVI.所有患者的LVEDP升高>12，平均压力为26mmHg，最低13mmHg，最高45mmHg,SD为7.85。
结论：评估肺部超声B线是确定AS患者肺水肿的一种简单而实用的方法。B线的数量与E/E比值和患者的功能状态相关，但与侵入性LVEDP或LVEF无关。所有患者的LVEDP升高与E/E'相关。
