Department of Internal Medicine and Cardiology, Osaka City University Medical School, Abeno-ku, Osaka, Japan.
Am J Cardiol. 2012 Jul 1;110(1):93-7. doi: 10.1016/j.amjcard.2012.02.056. Epub 2012 Apr 10.
Recently, an aortic valve area (AVA) index (AVAI) <0.6 cm(2)/m(2) was proposed as an indicator of severe aortic stenosis. The purpose of the present study was to clarify the prognostic value of the AVAI. We identified 103 consecutive asymptomatic patients (mean age 72 ± 11 years) with severe aortic stenosis, defined by an AVA of <1.0 cm(2), who had not undergone aortic valve replacement on initial evaluation. During follow-up (median 36 ± 27 months), 31 aortic valve replacements and 20 cardiac deaths occurred. Multivariate analysis revealed that an AVAI <0.6 cm(2)/m(2) (hazard ratio 2.6, 95% confidence interval 1.1 to 6.3; p = 0.03) and peak aortic jet velocity (Vp) >4.0 m/s (hazard ratio 2.6, 95% confidence interval 1.2 to 5.8; p = 0.02) were associated with cardiac events but that an AVA <0.75 cm(2) was not. The event-free survival of patients with an AVAI of ≥0.6 cm(2)/m(2) was better than that for those with an AVAI <0.6 cm(2)/m(2) (86% vs 41% at 3 years, p <0.01). Furthermore, patients with an AVAI of ≥0.6 cm(2)/m(2) and Vp of ≤4.0 m/s showed an excellent prognosis, but those without these findings had poorer outcomes. In conclusion, AVAI is a powerful predictor of adverse events in asymptomatic patients with severe aortic stenosis. Furthermore, the combination of AVAI and Vp provides additional prognostic information. Watchful observations are required for timely aortic valve replacement in patients with an AVAI of <0.6 cm(2)/m(2) or a Vp >4.0 m/s.
最近，提出了主动脉瓣口面积指数（AVAI）<0.6cm(2)/m(2)作为严重主动脉瓣狭窄的指标。本研究旨在明确 AVAI 的预后价值。我们确定了 103 例连续的无症状重度主动脉瓣狭窄患者（平均年龄 72±11 岁），这些患者在初始评估时未接受主动脉瓣置换术，其主动脉瓣口面积<1.0cm(2)。在随访期间（中位数 36±27 个月），31 例接受了主动脉瓣置换术，20 例发生了心脏死亡。多变量分析显示，AVAI<0.6cm(2)/m(2)（风险比 2.6，95%置信区间 1.1 至 6.3；p=0.03）和峰值主动脉射流速度（Vp）>4.0m/s（风险比 2.6，95%置信区间 1.2 至 5.8；p=0.02）与心脏事件相关，但 AVA<0.75cm(2)则无关。AVAI≥0.6cm(2)/m(2)的患者无事件生存率优于 AVA<0.6cm(2)/m(2)的患者（3 年时分别为 86%和 41%，p<0.01）。此外，AVAI≥0.6cm(2)/m(2)且 Vp≤4.0m/s 的患者预后良好，但无这些发现的患者预后较差。总之，AVAI 是无症状重度主动脉瓣狭窄患者不良事件的有力预测指标。此外，AVAI 和 Vp 的组合提供了额外的预后信息。对于 AVAI<0.6cm(2)/m(2)或 Vp>4.0m/s 的患者，需要密切观察，以便及时进行主动脉瓣置换术。
