2025 年第 1 期 第 0 卷

超声心动图诊断经导管主动脉瓣置换术后瓣叶血栓的价值研究

Value of echocardiography in the diagnosis of leaflet thrombosis after transcatheter aortic valve replacement

作者：谢萌  刘金凤  于惠梅  李晓明  吴山  张纯

英文作者：Xie Meng Liu Jinfeng Yu Huimei Li Xiaoming Wu Shan Zhang Chun

单位：首都医科大学附属北京安贞医院介入超声科，北京100029

英文单位：Department of Interventional Ultrasound Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：瓣叶血栓；  超声心动图；  经导管主动脉瓣置换术

英文关键词：Leafletthrombosis;  Echocardiography;  Transcatheteraorticvalvereplacement

• 摘要：

• 目的  探讨超声心动图诊断经导管主动脉瓣置换术（TAVR）后瓣叶血栓的价值。方法  选取2023年1月1日至7月1日于首都医科大学附属北京安贞医院成功接受TAVR治疗的患者115例作为研究对象。根据TAVR术后是否存在亚临床瓣叶血栓（SLT）分为正常组（85例）和血栓组（30例），根据SLT程度将血栓组分为轻度SLT组（17例）和中重度SLT组（13例）。比较患者的左心室舒张末期内径（LVEDD）、左心室射血分数（LVEF）、主动脉瓣峰值流速（Vmax）、平均跨瓣压差（MPG）、主动脉瓣口面积（AVA）、Vmax变化量（ΔVmax）、MPG变化量（ΔMPG）、AVA变化量（ΔAVA）、Vmax变化率（ΔVmax%）、MPG变化率（ΔMPG%）、AVA变化率（ΔAVA%）。采用受试者工作特征曲线分析中重度SLT形成的影响因素。结果  血栓组与正常组的LVEDD、LVEF、Vmax、MPG、AVA比较，差异均无统计学意义（均P＞0.05）。血栓组ΔVmax、ΔMPG、ΔVmax%、ΔMPG%均大于正常组，ΔAVA和ΔAVA%均小于正常组，差异均有统计学意义（均P＜0.05）。中重度SLT组、轻度SLT组、正常组LVEDD、LVEF、Vmax、MPG、AVA比较，差异均无统计学意义（均P＞0.05）。中重度SLT组、轻度SLT组、正常组ΔVmax、ΔMPG、ΔAVA、ΔVmax%、ΔMPG%比较，差异均有统计学意义（均P＜0.05）。中重度SLT组ΔVmax、ΔMPG、ΔVmax%、ΔMPG%均大于轻度SLT组和正常组，ΔAVA和ΔAVA%均小于正常组，ΔAVA小于轻度SLT组，差异均有统计学意义（均P＜0.05）。受试者工作特征曲线分析结果显示，ΔVmax＞77 cm/s、ΔMPG＞6 mmHg（1 mmHg=0.133 kPa）、ΔAVA≤-0.01 cm2、ΔVmax%＞35%、ΔMPG%＞143%预测TAVR术后中重度SLT的曲线下面积分别为0.754、0.733、0.726、0.784、0.788，特异度分别为80.4%、73.5%、65.7%、70.6%、90.2%，敏感度分别为61.5%、61.5%、76.9%、76.9%、61.5%（均P＜0.05）。结论  超声心动图对TAVR术后中重度SLT的形成有一定的诊断价值，ΔVmax、ΔMPG、ΔAVA、ΔVmax%、ΔMPG%可以对识别TAVR术后中重度SLT提供参考，且有一定的准确性。

• Objective  To investigate the value of echocardiography in the diagnosis of leaflet thrombosis after transcatheter aortic valve replacement (TAVR). Methods   A total of 115 patients who successfully underwent TAVR in Beijing Anzhen Hospital, Capital Medical University from January 1, 2023 to July 1, 2023 were selected as the research objects. According to the presence or absence of subclinical leaflet thrombosis (SLT) after TAVR, the patients were divided into normal group (85 cases) and thrombosis group (30 cases). According to the degree of SLT, the thrombosis group was divided into mild SLT group (17 cases) and moderate to severe SLT group (13 cases). Left ventricular end-diastolic diameter (LVEDD), left ventricular ejection fraction (LVEF), aortic valve peak velocity (Vmax), mean pressure gradient (MPG), aortic valve orifice area (AVA), amount of change in Vmax (ΔVmax), amount of change in MPG (ΔMPG), amount of change in AVA (ΔAVA), rate of change in Vmax (ΔVmax%), rate of change in MPG (ΔMPG%), and rate of change in AVA (ΔAVA%) were compared between the two groups. Receiver operating characteristic curve was used to analyze the influencing factors of moderate to severe SLT. Results   There were no significant differences in LVEDD, LVEF, Vmax, MPG and AVA between the thrombosis group and the normal group (all P＞0.05). The ΔVmax, ΔMPG, ΔVmax% and ΔMPG% in the thrombosis group were higher than those in the normal group, while the ΔAVA and ΔAVA% were lower than those in the normal group (all P＜0.05). There were no significant differences in LVEDD, LVEF, Vmax, MPG and AVA among the moderate to severe SLT group, mild SLT group and normal group (all P＞0.05). There were significant differences in ΔVmax, ΔMPG, ΔAVA, ΔVmax% and ΔMPG% among the moderate to severe SLT group, mild SLT group and normal group (all P＜0.05). The ΔVmax, ΔMPG, ΔVmax% and ΔMPG% in the moderate to severe SLT group were higher than those in the mild SLT group and the normal group, ΔAVA and ΔAVA% were lower than those in the normal group, and ΔAVA was lower than that in the mild SLT group (all P＜0.05). The results of receiver operating characteristic curve analysis showed that the areas under the curve of ΔVmax>77 cm/s, ΔMPG>6 mmHg, ΔAVA≤-0.01 cm2, ΔVmax%>35%, and ΔMPG%>143% for predicting moderate to severe SLT after TAVR were 0.754, 0.733, 0.726, 0.784 and 0.788, respectively, and the specificity were 80.4%, 73.5%, 65.7%, 70.6% and 90.2%, and the sensitivity were 61.5%, 61.5%, 76.9%, 76.9% and 61.5%, respectively (all P＜0.05). Conclusion   Echocardiography has a certain diagnostic value for the formation of moderate to severe SLT after TAVR. ΔVmax, ΔMPG, ΔAVA, ΔVmax% and ΔMPG% can provide a reference for the identification of moderate to severe SLT after TAVR with certain accuracy.