Rashedi Nina, Popović Zoran B, Stewart William J, Marwick Thomas
Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
J Am Soc Echocardiogr. 2014 Aug;27(8):829-37. doi: 10.1016/j.echo.2014.04.013. Epub 2014 May 27.
The outcomes of patients with mixed aortic valve disease (MAVD; concurrent aortic stenosis [AS] and aortic regurgitation [AR]) and its optimum management are undefined. The aim of this study was to evaluate the natural history of MAVD.
Between 2000 and 2005, 524 asymptomatic adults (mean age, 66 ± 14 years; 306 men) were identified who had mixed AS and AR, who did not undergo early intervention with surgery. The severity of AS and AR was defined using American Society of Echocardiography guideline criteria. Patients were followed over 5.5 ± 3.1 years.
Aortic valve replacement (AVR) was performed in 349 patients (67%), and 88 (17%) died. Angina, dyspnea, or syncope developed in 292 patients (84%) before AVR; baseline left ventricular mass and the severity of AS and AR were independent predictors of progression to AVR in the overall group. Survival was associated with younger age (hazard ratio, 1.08; P < .001) and valve replacement (hazard ratio, 0.61; P = .02). Most patients with MAVD in the moderate category progressed to severe AS or AR by the time of surgery (n = 51 [27%]); symptoms were the main indication in 22 patients. In this group, AVR was associated with age, left ventricular function, valve area, and the change in peak gradient over follow-up. In patients with moderate MAVD, coronary artery disease was present in 38 (20%) at baseline and developed in 21 (21%) during follow-up but was not associated with surgery. The average time to an event (AVR or death) in patients with MAVD was 4 years.
Careful surveillance of patients with MAVD is warranted, bearing in mind the composite severity of both AS and AR and their combined hemodynamic effects.
混合性主动脉瓣疾病（MAVD，即同时存在主动脉瓣狭窄[AS]和主动脉瓣反流[AR]）患者的预后及其最佳治疗方案尚不明确。本研究旨在评估MAVD的自然病程。
在2000年至2005年期间，共纳入524例无症状成年人（平均年龄66±14岁；男性306例），这些患者同时患有AS和AR，且未接受早期手术干预。AS和AR的严重程度根据美国超声心动图学会指南标准进行定义。对患者进行了5.5±3.1年的随访。
349例患者（67%）接受了主动脉瓣置换术（AVR），88例（17%）死亡。292例患者（84%）在接受AVR之前出现了心绞痛、呼吸困难或晕厥；基线左心室质量以及AS和AR的严重程度是整个研究组中进展至AVR的独立预测因素。生存率与较年轻的年龄（风险比，1.08；P<.001）和瓣膜置换术（风险比，0.61；P=.02）相关。大多数中度MAVD患者在手术时进展为重度AS或AR（n=51[27%]）；症状是22例患者的主要手术指征。在该组中，AVR与年龄、左心室功能、瓣膜面积以及随访期间峰值梯度的变化有关。在中度MAVD患者中，38例（20%）在基线时存在冠状动脉疾病，随访期间有21例（21%）发生冠状动脉疾病，但与手术无关。MAVD患者发生事件（AVR或死亡）的平均时间为4年。
鉴于AS和AR的综合严重程度及其联合血流动力学效应，有必要对MAVD患者进行仔细监测。
