Wakabayashi Kana, Tsujino Takeshi, Naito Yoshiro, Ezumi Akira, Lee-Kawabata Masaaki, Nakao Shinji, Goda Akiko, Sakata Yasushi, Yamamoto Kazuhiro, Daimon Takashi, Masuyama Tohru
Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, 663-8501, Japan.
Heart Vessels. 2011 May;26(3):252-7. doi: 10.1007/s00380-010-0052-x. Epub 2010 Nov 10.
It is almost unknown which demographic factors or medications affect the progression of aortic stenosis (AS) in Japanese patients with mild AS. We identified a total of 194 patients with native tricuspid valvular AS, defined as a continuous-wave Doppler determined peak aortic valve jet velocity of ≥ 2.0 m/s, in whom echo Doppler studies were repeated at an interim of at least 6 months. Annualized change in peak jet velocity was calculated, and effects of age, sex, diabetes mellitus, blood pressure, serum low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglyceride levels, and use of statins and antihypertensive agents on the progression of AS were retrospectively evaluated. Peak aortic valve jet velocity was 2.36 ± 0.79 m/s (mean ± SD) and annualized increase in peak aortic valve jet velocity was 0.17 ± 0.32 m/s/year for all the studied patients. The increase in peak aortic valve jet velocity was lower in patients taking angiotensin-converting enzyme inhibitors (ACE-Is) than in those not taking ACE-Is (0.04 ± 0.22 vs. 0.20 ± 0.32 m/s/year, P < 0.05). Such protective associations were not observed for other first-line antihypertensive agents and statins. Multiple linear regression analysis revealed that ACE-I treatment, decrease in left ventricular ejection fraction, and higher peak aortic valve jet velocity at the first echocardiogram were associated with slower progression of AS. Administration of ACE-Is was associated with the slow progression of mild AS in Japanese patients. Prospective study to assess this hypothesis is needed.
在日本轻度主动脉瓣狭窄（AS）患者中，几乎不清楚哪些人口统计学因素或药物会影响AS的进展。我们共纳入了194例原发性三尖瓣主动脉瓣狭窄患者，定义为连续波多普勒测定的主动脉瓣峰值射流速度≥2.0 m/s，这些患者至少每6个月进行一次超声多普勒检查。计算峰值射流速度的年化变化，并回顾性评估年龄、性别、糖尿病、血压、血清低密度脂蛋白胆固醇、高密度脂蛋白胆固醇和甘油三酯水平，以及他汀类药物和抗高血压药物对AS进展的影响。所有研究患者的主动脉瓣峰值射流速度为2.36±0.79 m/s（均值±标准差），主动脉瓣峰值射流速度的年化增加为0.17±0.32 m/s/年。服用血管紧张素转换酶抑制剂（ACE-Is）的患者主动脉瓣峰值射流速度的增加低于未服用ACE-Is的患者（0.04±0.22 vs. 0.20±0.32 m/s/年，P<0.05）。对于其他一线抗高血压药物和他汀类药物，未观察到这种保护关联。多元线性回归分析显示，ACE-I治疗、左心室射血分数降低以及首次超声心动图时较高的主动脉瓣峰值射流速度与AS进展较慢相关。在日本患者中，服用ACE-Is与轻度AS进展缓慢有关。需要进行前瞻性研究来评估这一假设。
