Beth Israel Deaconess Medical Center (Cardiovascular Division) and Harvard Medical School, Boston, Mass.
Am J Med. 2013 Dec;126(12):1035-42. doi: 10.1016/j.amjmed.2013.05.022. Epub 2013 Oct 11.
Valvular heart disease is both prevalent and increases with age. The final pathway of valvular disease is heart failure and sometimes sudden death, so clinicians must identify and treat it before these endpoints occur. Noninvasive diagnostic modalities such as echocardiography, exercise tolerance testing, and cardiac magnetic resonance provide additional quantitative, qualitative, and prognostic data. Studies have elucidated predictors of disease progression and potential medical therapies, but the niche of valvular disease has benefited relatively less from randomized controlled clinical trials than other cardiovascular disease fields. New invasive techniques like transcatheter valve replacement offer hope for high-risk operative candidates. We review classic teaching with current guidelines and emphasize recent advances in disease management.
瓣膜性心脏病既普遍又随年龄增长而增加。瓣膜病的最终途径是心力衰竭，有时是猝死，因此临床医生必须在这些终点发生之前识别和治疗它。超声心动图、运动耐量测试和心脏磁共振等非侵入性诊断方式提供了额外的定量、定性和预后数据。研究已经阐明了疾病进展的预测因素和潜在的药物治疗方法，但与其他心血管疾病领域相比，瓣膜病领域相对较少受益于随机对照临床试验。经导管瓣膜置换等新的介入技术为高危手术患者带来了希望。我们复习了经典的教学内容和当前的指南，并强调了疾病管理方面的最新进展。
