老年退行性心脏瓣膜病患者超声心动图参数变化与瓣膜钙化的相关性分析

Correlation analysis of changes in echocardiographic parameters and valvular calcification in elderly patients with degenerative heart valvular disease

摘要:

目的]探究老年退行性心脏瓣膜病(SDHVD)患者超声心动图改变与瓣膜钙化的相关性。 [方法]选取2023年2月—2025年12月东南大学附属中大医院江北院区收治的327例SDHVD患者为研究对象,以临床综合诊断结果为金标准,根据患者是否发生瓣膜钙化分为瓣膜钙化组(n＝254)和非瓣膜钙化组(n＝73),比较两组患者的临床资料及超声心动图参数。多因素Logistic回归分析瓣膜钙化的影响因素以及超声心动图参数与瓣膜钙化的相关性,限制性立方样条模型分析超声心动图参数与瓣膜钙化的剂量-反应关系,ROC曲线分析超声心动图参数对瓣膜钙化的诊断效能。 [结果]经临床综合诊断,327例患者中,瓣膜钙化254例,非瓣膜钙化73例。超声心动图检出瓣膜钙化246例,灵敏度94.88%,准确率为94.50%,与临床诊断的一致性良好(Kappa值=0.658)。瓣膜钙化组左心室舒张期末容积(LVEDV)、左心室收缩期末容积(LVESV)、左心室收缩期末内径(LVESD)、左心室舒张期末内径(LVEDD)、左心房内径(LAD)、二尖瓣舒张晚期血流速度(A)大于非瓣膜钙化组,二尖瓣舒张早期血流速度(E)小于非瓣膜钙化组(P＜0.05)；主动脉瓣及二尖瓣厚度大于非瓣膜钙化组,主动脉瓣强回声、主动脉瓣活动受限、二尖瓣强回声、二尖瓣增厚及腱索人数占比更高(P＜0.05)。多因素Logistic回归分析结果显示,高龄、高血压、高血脂及LVEDV、LVESV、LVEDD、LAD、A增大是患者发生瓣膜钙化的危险因素,E增大是保护因素。校正混杂因素后显示,LVEDV、LVESV、LVEDD、LAD及A增大与瓣膜钙化呈正相关,E增大与瓣膜钙化呈负相关。ROC曲线分析结果显示,LVEDV、LVESV、LVEDD、LAD、E、A联合检测对瓣膜钙化的诊断效能最高,ROC曲线下面积为0.954。 [结论]SDHVD患者LVEDV、LVESV、LVEDD、LAD及A增大与瓣膜钙化呈正相关,E增大与瓣膜钙化呈负相关,上述超声心动图参数联合检测对瓣膜钙化具有较高的诊断效能,对临床诊断具有重要意义。

Abstract:

Aim To investigate the correlation between echocardiographic changes and valvular calcification in elderly patients with senile degenerative heart valvular disease (SDHVD). Methods A total of 327 elderly patients with SDHVD admitted to Jiangbei Hospital, Zhongda Hospital Affiliated to Southeast University from February 2023 to December 2025 were enrolled in this study. With comprehensive clinical diagnosis as the gold standard, the patients were divided into valvular calcification group (n＝254) and non-valvular calcification group (n＝73) according to the presence or absence of valvular calcification. Clinical data and echocardiographic parameters were compared between the two groups. Multivariate Logistic regression analysis was performed to identify influencing factors of valvular calcification and to evaluate the correlation between echocardiographic parameters and valvular calcification. A restricted cubic spline model was employed to analyze the dose-response relationship between echocardiographic parameters and valvular calcification. Receiver operating characteristic (ROC) curves were constructed to assess the diagnostic efficacy of echocardiographic parameters for valvular calcification. Results Among 327 patients, 254 were diagnosed with valvular calcification and 73 without, based on comprehensive clinical diagnosis. Echocardiography detected 246 cases of valvular calcification, with a sensitivity of 94.88%, accuracy of 94.50%, demonstrating good consistency with clinical diagnosis (Kappa=0.658). The valvular calcification group had greater left ventricular end diastolic volume (LVEDV), left ventricular end systolic volume (LVESV), left ventricular end systolic diameter (LVESD), left ventricular end diastolic diameter (LVEDD), left atrial diameter (LAD) and late diastolic mitral inflow velocity (A) than the non-valvular calcification group, while early diastolic mitral inflow velocity (E) was lower in the valvular calcification group (P＜0.05). Aortic valve thickness and mitral valve thicknesses were greater in the valvular calcification group, and the proportions of patients with aortic valve hyperechogenicity, restricted aortic valve mobility, mitral valve hyperechogenicity, mitral valve thickening, and chordal involvement were higher in the valvular calcification group (P＜0.05). Multivariate Logistic regression analysis showed that advanced age, hypertension, hyperlipidemia, and increased LVEDV, LVESV, LVEDD, LAD, and A were risk factors for valvular calcification, whereas increased E was a protective factor. After adjusting for confounding factors, increased LVEDV, LVESV, LVEDD, LAD, and A were positively correlated with valvular calcification, while increased E was negatively correlated with valvular calcification. ROC curve analysis demonstrated that the combined detection of LVEDV, LVESV, LVEDD, LAD, E, and A achieved the highest diagnostic efficacy for valvular calcification, with an area under the curve (AUC) of 0.954. Conclusion In patients with SDHVD, increased LVEDV, LVESV, LVEDD, LAD, and A are positively correlated with valvular calcification, while increased E is negatively correlated with valvular calcification. The combined detection of these echocardiographic parameters demonstrates high diagnostic efficacy for valvular calcification and is of great significance for clinical diagnosis.