Division of Cardiology, Loma Linda University Medical Center, Loma Linda, California 92354, USA.
Ann Thorac Surg. 2010 Mar;89(3):731-7. doi: 10.1016/j.athoracsur.2009.12.008.
According to American College of Cardiology/American Heart Association guidelines, isolated aortic valve replacement (AVR) is a class III indication for patients with asymptomatic chronic severe aortic regurgitation (AR), left ventricular (LV) ejection fraction (EF) greater than 50%, LV end-diastolic dimension less than 70 mm, and LV end-systolic dimension less than 50 mm.
We screened our echocardiographic database for all chronic severe AR patients between 1993 and 2007. Chart reviews were performed to collect clinical, demographic, and pharmacological data. Mortality was analyzed as a function of AVR.
In all, 123 patients were found to have chronic severe asymptomatic AR; they had a mean age of 60 +/- 17 years and mean LVEF of 60% +/- 15%. A subgroup of 79 patients was found to have asymptomatic severe AR with an LVEF greater than 50%, LV end-diastolic dimension less than 70 mm, and LV end-systolic dimension less than 50 mm. By Kaplan-Meier analysis, patients not undergoing AVR had 1-, 5-, and 10-year survival rates of 86%, 71%, and 46%, respectively, compared with 100%, 94%, and 94%, respectively, for patients who underwent AVR (p = 0.004). Aortic valve replacement remained an independent predictor of increased survival after adjusting for group differences and univariate predictors of mortality. The benefit of AVR was further supported by propensity score analysis.
Despite serving as a class III indication, AVR is independently associated with increased survival among patients with severe asymptomatic AR, LVEF greater than 50%, LV end-diastolic dimension less than 70 mm, and LV end-systolic dimension less than 50 mm.
根据美国心脏病学会/美国心脏协会的指南，对于无症状慢性重度主动脉瓣反流（AR）、左心室（LV）射血分数（EF）大于 50%、LV 舒张末期内径小于 70mm 且 LV 收缩末期内径小于 50mm 的患者，孤立性主动脉瓣置换（AVR）是 III 类适应证。
我们筛选了 1993 年至 2007 年期间所有慢性重度 AR 患者的超声心动图数据库。进行图表审查以收集临床、人口统计学和药物治疗数据。分析了死亡率与 AVR 的关系。
共有 123 例患者被诊断为慢性无症状重度 AR，平均年龄为 60±17 岁，平均 LVEF 为 60%±15%。发现 79 例亚组患者患有无症状重度 AR，EF 大于 50%，LV 舒张末期内径小于 70mm，LV 收缩末期内径小于 50mm。通过 Kaplan-Meier 分析，未行 AVR 的患者 1 年、5 年和 10 年生存率分别为 86%、71%和 46%，而行 AVR 的患者分别为 100%、94%和 94%（p=0.004）。在调整组间差异和死亡率的单因素预测因素后，AVR 仍然是生存率增加的独立预测因素。倾向评分分析进一步支持了 AVR 的获益。
尽管作为 III 类适应证，但 AVR 与严重无症状 AR、EF 大于 50%、LV 舒张末期内径小于 70mm 和 LV 收缩末期内径小于 50mm 的患者生存率增加独立相关。
