Department of Cardiovascular Medicine, Cleveland Clinic, Ohio 44195, USA.
J Am Coll Cardiol. 2012 Apr 17;59(16):1452-9. doi: 10.1016/j.jacc.2012.01.024.
The aim of this study was to investigate the impact of bisphosphonates on the progression of aortic stenosis.
Valvular calcification is associated with the development and progression of aortic stenosis. Bisphosphonates have been suggested to slow this progression.
Female patients older than the age of 60 years with an aortic valve area (AVA) between 1.0 and 2.0 cm(2) were identified and studied retrospectively. Only those who had follow-up echocardiograms at least a year apart were included. Primary outcomes were the change in AVA and valvular gradients over time. Mortality and freedom from aortic valve replacement were also studied. A propensity-matching method was applied for the probability of the use of bisphosphonates.
The study included 801 female patients (mean age, 76 ± 7.6 years) with a mean follow-up of 5.1 ± 2.4 years. The mean duration of bisphosphonate use was 3.1 ± 2.6 years. At the time of the initial echocardiogram, 323 patients (38%) were taking bisphosphonates. The mean ejection fraction at baseline was 56.7 ± 9.6% with a mean AVA of 1.32 ± 0.25 cm(2). Peak and mean gradients were 28.4 ± 11 mm Hg and 15.6 ± 6.8 mm Hg, respectively. Propensity matching was successfully performed for 438 patients. On follow-up, there were no differences in the rate of change in AVA or peak and mean gradients when patients were stratified based on the use of bisphosphonates. Bisphosphonates also had no impact on survival or freedom from aortic valve replacement.
In this retrospective analysis of older female patients, bisphosphonates do not have a significant impact on the hemodynamic or clinical progression of aortic stenosis.
本研究旨在探讨双膦酸盐对主动脉瓣狭窄进展的影响。
瓣膜钙化与主动脉瓣狭窄的发生和进展相关。双膦酸盐类药物已被证实可减缓这一进展。
回顾性分析年龄大于 60 岁、主动脉瓣瓣口面积（AVA）在 1.0 至 2.0cm²之间的女性患者。仅纳入至少有一次间隔一年以上的超声心动图随访的患者。主要终点为 AVA 和瓣膜跨瓣压差随时间的变化。同时还研究了死亡率和免于主动脉瓣置换的情况。采用倾向评分匹配法来评估使用双膦酸盐的概率。
研究纳入 801 名女性患者（平均年龄 76 ± 7.6 岁），平均随访时间为 5.1 ± 2.4 年。双膦酸盐的平均使用时间为 3.1 ± 2.6 年。在初次超声心动图检查时，323 名患者（38%）正在服用双膦酸盐。基线时平均射血分数为 56.7 ± 9.6%，平均 AVA 为 1.32 ± 0.25cm²。峰值和平均跨瓣压差分别为 28.4 ± 11mmHg 和 15.6 ± 6.8mmHg。成功为 438 名患者进行了倾向评分匹配。随访时，根据双膦酸盐的使用情况对患者进行分层，AVA 或峰值和平均跨瓣压差的变化率无差异。双膦酸盐类药物也对生存或免于主动脉瓣置换无影响。
在这项对老年女性患者的回顾性分析中，双膦酸盐类药物对主动脉瓣狭窄的血流动力学或临床进展没有显著影响。
