Department of Cardiology, Heart Valve Clinic, University Hospital Sart Tilman, University of Liège, Liège, Belgium.
J Am Coll Cardiol. 2012 Jan 17;59(3):235-43. doi: 10.1016/j.jacc.2011.08.072.
This study examined the clinical course of patients with asymptomatic severe aortic stenosis (AS) according to the new proposed aortic valve stenosis grading classification.
The management of patients with asymptomatic severe AS remains controversial. Moreover, under the same denomination of severe AS, several entities might be identified according to transvalvular flow rates and pressure gradients, resulting in 4 flow-gradient patterns.
Transthoracic echocardiography and measurement of B-type natriuretic peptide level from venous blood sample were performed in 150 consecutive patients with asymptomatic severe AS and normal exercise test. Patients were classified in 4 groups, depending on left ventricular flow state (normal flow [NF] vs. low flow [LF]: 35 ml/m(2)) and pressure gradient levels (low gradient [LG] vs. high gradient [HG]: 40 mm Hg).
Patients with NF/LG had significantly lower B-type natriuretic peptide than those with LF/HG and LF/LG. The mean follow-up was 27 ± 12 months. At 2 years, cardiac event-free survival was 83 ± 6%, 44 ± 6%, 30 ± 12%, and 27 ± 13% in NF/LG, NF/HG, LF/HG, and LF/LG groups, respectively (p < 0.0001). On multivariable analysis, LF/LG (hazard ratio [HR]: 5.26, 95% confidence interval [CI]: 2.04 to 14.3, p = 0.045) and LF/HG (HR: 2.38, 95% CI: 1.02 to 5.55, p = 0.001) were identified as strong independent determinants of poor prognosis as compared with NF/HG. By limiting the multivariable analysis to patients with LF, LF/LG was an independent predictor of markedly reduced cardiac event-free survival when compared with LF/HG (HR: 5.4, 95% CI: 1.03 to 28.6, p = 0.046).
The use of the new proposed AS grading classification integrating valve area and flow-gradient patterns allows a better characterization of the clinical outcome of patients with asymptomatic severe AS.
本研究根据新提出的主动脉瓣狭窄分级分类，检查无症状严重主动脉瓣狭窄（AS）患者的临床病程。
无症状严重 AS 患者的治疗仍存在争议。此外，在相同的严重 AS 名称下，根据跨瓣血流速度和压力梯度，可以识别出几种实体，导致 4 种流量-梯度模式。
对 150 例连续无症状严重 AS 且运动试验正常的患者进行经胸超声心动图和静脉血 B 型利钠肽水平测量。根据左心室血流状态（正常流量 [NF]与低流量 [LF]：35ml/m²）和压力梯度水平（低梯度 [LG]与高梯度 [HG]：40mmHg），将患者分为 4 组。
NF/LG 患者的 B 型利钠肽明显低于 LF/HG 和 LF/LG 患者。平均随访 27±12 个月。2 年时，NF/LG、NF/HG、LF/HG 和 LF/LG 组的无心脏事件生存率分别为 83±6%、44±6%、30±12%和 27±13%（p<0.0001）。多变量分析显示，LF/LG（危险比 [HR]：5.26，95%置信区间 [CI]：2.04 至 14.3，p=0.045）和 LF/HG（HR：2.38，95%CI：1.02 至 5.55，p=0.001）是 NF/HG 预后不良的独立强预测因素。通过将多变量分析限制在 LF 患者中，与 LF/HG 相比，LF/LG 是明显降低无心脏事件生存率的独立预测因素（HR：5.4，95%CI：1.03 至 28.6，p=0.046）。
新提出的 AS 分级分类整合了瓣膜面积和流量-梯度模式，可更好地描述无症状严重 AS 患者的临床结局。
