Chandra Harish R, Goldstein James A, Choudhary Nivedita, O'Neill Carol S, George Peter B, Gangasani Sreenivasulu R, Cronin Lynn, Marcovitz Pamela A, Hauser Andrew M, O'Neill William W
Division of Cardiology, Department of Internal Medicine, William Beaumont Hospital, Royal Oak, Michigan 48073, USA.
J Am Coll Cardiol. 2004 Jan 21;43(2):169-75. doi: 10.1016/j.jacc.2003.08.036.
The present study was designed to evaluate the relationship between the presence of aortic sclerosis, serologic markers of inflammation, and adverse cardiovascular outcomes.
Aortic sclerosis is associated with adverse cardiovascular outcomes. However, the mechanism by which such nonobstructive valve lesions impart excess cardiovascular risk has not been delineated.
In 425 patients (mean age 68 +/- 15 years, 54% men) presenting to the emergency room with chest pain, we studied the relationship among aortic sclerosis, the presence and acuity of coronary artery disease, serologic markers of inflammation, and cardiovascular outcomes. Patients underwent echocardiography and serologic testing including C-reactive protein (CRP). Aortic valves were graded for the degree of sclerosis, and cardiovascular outcomes including cardiac death and nonfatal myocardial infarction (MI) were analyzed over one year.
Aortic sclerosis was identified in 203 patients (49%), whereas 212 (51%) had normal aortic valves. On univariate analysis at one year, patients with aortic sclerosis had a higher incidence of cardiovascular events (16.8% vs. 7.1%, p = 0.002) and worse event-free survival (normal valves = 93%, mild aortic sclerosis = 85%, and moderate to severe aortic sclerosis = 77%, p = 0.002). However, by multivariable analysis aortic sclerosis was not independently associated with adverse cardiovascular outcomes; the only independent predictors of cardiac death or MI at one year were coronary artery disease (hazard ratio [HR] 3.23, p = 0.003), MI at index admission (HR 2.77, p = 0.008), ascending tertiles of CRP (HR 2.2, p = 0.001), congestive heart failure (HR 2.15, p = 0.02) and age (HR 1.03, p = 0.04).
The increased incidence of adverse cardiovascular events in patients with aortic sclerosis is associated with coronary artery disease and inflammation, not a result of the effects of valvular heart disease per se.
本研究旨在评估主动脉硬化的存在、炎症血清学标志物与不良心血管结局之间的关系。
主动脉硬化与不良心血管结局相关。然而，这种非阻塞性瓣膜病变导致心血管风险增加的机制尚未明确。
在425例因胸痛就诊于急诊室的患者（平均年龄68±15岁，54%为男性）中，我们研究了主动脉硬化、冠状动脉疾病的存在及严重程度、炎症血清学标志物与心血管结局之间的关系。患者接受了超声心动图检查和包括C反应蛋白（CRP）在内的血清学检测。对主动脉瓣的硬化程度进行分级，并分析了一年内心血管结局，包括心源性死亡和非致命性心肌梗死（MI）。
203例患者（49%）被诊断为主动脉硬化，而212例（51%）主动脉瓣正常。在一年的单因素分析中，主动脉硬化患者心血管事件的发生率较高（16.8%对7.1%，p = 0.002），无事件生存率较差（正常瓣膜组 = 93%，轻度主动脉硬化组 = 85%，中度至重度主动脉硬化组 = 77%，p = 0.002）。然而，通过多变量分析，主动脉硬化与不良心血管结局无独立相关性；一年内心源性死亡或MI的唯一独立预测因素是冠状动脉疾病（风险比[HR] 3.23，p = 0.003）、首次入院时的MI（HR 2.77，p = 0.008）、CRP的三分位数升高（HR 2.2，p = 0.001）、充血性心力衰竭（HR 2.15，p = 0.02）和年龄（HR 1.03，p = 0.04）。
主动脉硬化患者不良心血管事件发生率增加与冠状动脉疾病和炎症有关，而非瓣膜性心脏病本身的影响所致。
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