Bruch Christian, Kauling Daniela, Reinecke Holger, Rothenburger Markus, Scheld Hans Heinrich, Breithardt Günter, Wichter Thomas
Universitätsklinikum Münster, Medizinische Klinik und Poliklinik C (Kardiologie und Angiologie), Albert-Schweitzer-Str. 33, 48129 Münster, Germany.
Clin Res Cardiol. 2007 Jan;96(1):23-9. doi: 10.1007/s00392-006-0452-1. Epub 2006 Oct 30.
In patients with severe aortic valve stenosis (valve area <or= 1 cm(2), AS), the prevalence and the prognostic impact of comorbidities is unknown. Fifty-eight patients with severe AS (mean aortic valve area 0.8 +/- 0.2 cm(2)), who underwent cardiac catheterization and 2-D/Doppler echocardiography, were prospectively enrolled. The glomerular filtration rate (eGFR) was estimated using the abbreviated Modification of Diet in Renal Disease Study equation. Death from a cardiac cause was defined as study end point. Coronary artery disease was present in 33 patients (57%). Subsequently, 43 patients (77%) underwent aortic valve replacement. During a follow-up of 485 +/- 336 days, 11 patients suffered a cardiac death. Survivors and non-survivors did not differ with respect the prevalence of coronary artery disease, invasive hemodynamic measurements or echocardiographic variables of systolic/diastolic function. Non-survivors were in a poorer NYHA functional class (3.2 +/- 0.3 vs 2.4+/-0.8, p = 0.002), had a lower eGFR (33.4 +/- 15.5 ml/min/1.73 m(2) vs 49.1 +/- 15.6 ml/min/1.73m(2), p = 0.004), a higher prevalence of diabetes mellitus (73% vs. 22%, p = 0.0001) and a lower serum hemoglobin level (11.6 +/- 2.1 vs 13.0 +/- 1.5 g/dL, p = 0.017). By multivariate Cox analysis, NYHA class (hazard ratio: 6.17, p = 0.013) and eGFR (hazard ratio 0.95, p = 0.04) were independent prognostic predictors. In patients with eGFR < 41.8 ml/min/1.73 m(2) (cut-off value derived from ROC analysis, area under the curve: 0.78 +/- 0.08), outcome was markedly poorer as compared to patients with eGFR > 41.8 ml/min/1.73 m(2) (event-free survival rate of 38% vs 93%, p = 0.004). Thus, in patients with severe AS, comorbidities are frequent, and particularly kidney disease significantly impacts longterm outcome.
在重度主动脉瓣狭窄（瓣膜面积≤1平方厘米，AS）患者中，合并症的患病率及其对预后的影响尚不清楚。前瞻性纳入了58例重度AS患者（平均主动脉瓣面积0.8±0.2平方厘米），这些患者均接受了心导管检查和二维/多普勒超声心动图检查。采用简化的肾脏疾病饮食改良研究方程估算肾小球滤过率（eGFR）。将心源性死亡定义为研究终点。33例患者（57%）存在冠状动脉疾病。随后，43例患者（77%）接受了主动脉瓣置换术。在485±336天的随访期内，11例患者发生心源性死亡。存活者和非存活者在冠状动脉疾病患病率、有创血流动力学测量或收缩/舒张功能的超声心动图变量方面无差异。非存活者的纽约心脏协会（NYHA）功能分级较差（3.2±0.3对2.4±0.8，p = 0.002），eGFR较低（33.4±15.5毫升/分钟/1.73平方米对49.1±15.6毫升/分钟/1.73平方米，p = 0.004），糖尿病患病率较高（73%对22%，p = 0.0001），血清血红蛋白水平较低（11.6±2.1对13.0±1.5克/分升，p = 0.017）。通过多变量Cox分析，NYHA分级（风险比：6.17，p = 0.013）和eGFR（风险比0.95，p = 0.04）是独立的预后预测因素。与eGFR＞41.8毫升/分钟/1.73平方米的患者相比，eGFR＜41.8毫升/分钟/1.73平方米（根据ROC分析得出的截断值，曲线下面积：0.78±0.08）的患者预后明显较差（无事件生存率为38%对93%，p = 0.004）。因此，在重度AS患者中，合并症很常见，尤其是肾脏疾病对长期预后有显著影响。
