Department of Cardiology, Odense University Hospital, Odense, Denmark.
Circ Cardiovasc Imaging. 2014 Jan;7(1):142-8. doi: 10.1161/CIRCIMAGING.113.000636. Epub 2013 Oct 30.
In aortic valve stenosis (AS), the occurrence of heart failure symptoms does not always correlate with severity of valve stenosis and left ventricular (LV) function. Therefore, we tested the hypothesis that symptomatic patients with AS have impaired diastolic, longitudinal systolic function, and left atrial dilatation compared with asymptomatic patients.
In a retrospective descriptive study, we compared clinical characteristics and echocardiographic parameters in 99 symptomatic and 139 asymptomatic patients with severe AS and LV ejection fraction ≥50%. Independent predictors of symptomatic state were identified using logistic regression analysis. Symptomatic patients were younger (72±10 versus 76±12 years of age; P=0.002), presented less often with atrial fibrillation (13% versus 24%; P=0.05) and chronic obstructive pulmonary disease (2% versus 19%; P<0.001), and had a lower prevalence of hypertension (73% versus 40%; P<0.001). Despite similar AS severity, symptomatic patients had higher LV mass index (120±39 versus 95±25 g/m2; P<0.0001), increased relative wall thickness (0.61±0.15 versus 0.50±0.11; P<0.0001), shorter mitral deceleration time (199±58 versus 268±62 ms; P<0.0001), and increased left atrial volume index (49±18 versus 42±15 mL/m2; P=0.02). When adjusting for age, history of hypertension, atrial fibrillation, and chronic obstructive pulmonary disease in a multivariable logistic regression analysis, LV mass index, relative wall thickness, left atrial volume index, and deceleration time were still associated with the presence of symptoms.
The present study demonstrates that symptomatic status in severe AS is associated with impaired diastolic function, LV hypertrophy, concentric remodeling, and left atrial dilatation when corrected for indices of AS severity.
URL: http://www.clinicaltrials.gov. Unique identifier: NCT00294775.
在主动脉瓣狭窄（AS）中，心力衰竭症状的发生并不总是与瓣狭窄的严重程度和左心室（LV）功能相关。因此，我们检验了这样一个假设，即有症状的 AS 患者与无症状患者相比，存在舒张功能障碍、纵向收缩功能障碍和左心房扩张。
在一项回顾性描述性研究中，我们比较了 99 例有症状和 139 例无症状的严重 AS 且 LV 射血分数≥50%的患者的临床特征和超声心动图参数。使用逻辑回归分析确定有症状状态的独立预测因素。有症状的患者更年轻（72±10 岁 vs 76±12 岁；P=0.002），心房颤动（13% vs 24%；P=0.05）和慢性阻塞性肺疾病（2% vs 19%；P<0.001）的发生率较低，高血压的患病率较低（73% vs 40%；P<0.001）。尽管 AS 严重程度相似，但有症状的患者 LV 质量指数更高（120±39 克/平方米 vs 95±25 克/平方米；P<0.0001），相对壁厚度更大（0.61±0.15 比 0.50±0.11；P<0.0001），二尖瓣减速时间更短（199±58 毫秒 vs 268±62 毫秒；P<0.0001），左心房容积指数更大（49±18 毫升/平方米 vs 42±15 毫升/平方米；P=0.02）。在多变量逻辑回归分析中，当调整年龄、高血压史、心房颤动和慢性阻塞性肺疾病时，LV 质量指数、相对壁厚度、左心房容积指数和减速时间与症状的存在仍相关。
本研究表明，在严重 AS 中，症状状态与舒张功能障碍、LV 肥厚、向心性重构和左心房扩张有关，这些与 AS 严重程度的指标有关。
