Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France INSERM U698, Bichat Hospital, Paris, France University Paris 7, Paris, France.
Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France INSERM U698, Bichat Hospital, Paris, France.
Heart. 2015 Jun;101(12):943-7. doi: 10.1136/heartjnl-2014-307154. Epub 2015 Feb 5.
Aortic valve stenosis (AS) is a progressive disease, but the impact of baseline AS haemodynamic or anatomic severity on AS progression remains unclear.
In 149 patients (104 mild AS, 36 moderate AS and 9 severe AS) enrolled in 2 ongoing prospective cohorts (COFRASA/GENERAC), we evaluated AS haemodynamic severity at baseline and yearly, thereafter, using echocardiography (mean pressure gradient (MPG)) and AS anatomic severity using CT (degree of aortic valve calcification (AVC)).
After a mean follow-up of 2.9±1.0 years, mean MGP increased from 22±11 to 30±16 mm Hg (+3±3 mm Hg/year), and mean AVC from 1108±891 to 1640±1251 AU (arbitrary units) (+188±176 AU/year). Progression of AS was strongly related to baseline haemodynamic severity (+2±3 mm Hg/year in mild AS, +4±3 mm Hg/year in moderate AS and +5±5 mm Hg/year in severe AS (p=0.01)), and baseline haemodynamic severity was an independent predictor of haemodynamic progression (p=0.0003). Annualised haemodynamic and anatomic progression rates were significantly correlated (r=0.55, p<0.0001), but AVC progression rate was also significantly associated with baseline haemodynamic severity (+141±133 AU/year in mild AS, +279±189 AU/year in moderate AS and +361±293 AU/year in severe AS, p<0.0001), and both baseline MPG and baseline AVC were independent determinants of AVC progression (p<0.0001).
AS progressed faster with increasing haemodynamic or anatomic severity. Our results suggest that a medical strategy aimed at preventing AVC progression may be useful in all subsets of patients with AS including those with severe AS and support the recommended closer follow-up of patients with AS as AS severity increases.
COFRASA (clinicalTrial.gov number NCT 00338676) and GENERAC (clinicalTrial.gov number NCT00647088).
主动脉瓣狭窄（AS）是一种进行性疾病，但基线时 AS 血流动力学或解剖严重程度对 AS 进展的影响尚不清楚。
在 2 项正在进行的前瞻性队列研究（COFRASA/GENERAC）中，纳入了 149 名患者（104 例轻度 AS，36 例中度 AS 和 9 例重度 AS），我们使用超声心动图（平均压力梯度（MPG））评估基线和每年的 AS 血流动力学严重程度，使用 CT（主动脉瓣钙化程度（AVC））评估 AS 解剖严重程度。
平均随访 2.9±1.0 年后，平均 MPG 从 22±11 增加到 30±16 mm Hg（每年增加 3±3 mm Hg），平均 AVC 从 1108±891 增加到 1640±1251 AU（任意单位）（每年增加 188±176 AU）。AS 的进展与基线血流动力学严重程度密切相关（轻度 AS 每年增加 2±3 mm Hg，中度 AS 每年增加 4±3 mm Hg，重度 AS 每年增加 5±5 mm Hg（p=0.01）），并且基线血流动力学严重程度是血流动力学进展的独立预测因素（p=0.0003）。每年的血流动力学和解剖学进展率显著相关（r=0.55，p<0.0001），但 AVC 进展率也与基线血流动力学严重程度显著相关（轻度 AS 每年增加 141±133 AU，中度 AS 每年增加 279±189 AU，重度 AS 每年增加 361±293 AU，p<0.0001），并且基线 MPG 和基线 AVC 都是 AVC 进展的独立决定因素（p<0.0001）。
随着血流动力学或解剖严重程度的增加，AS 的进展速度更快。我们的结果表明，旨在预防 AVC 进展的医疗策略可能对包括重度 AS 患者在内的所有 AS 患者亚组都有用，并支持随着 AS 严重程度的增加，建议对 AS 患者进行更密切的随访。
COFRASA（clinicalTrial.gov 编号 NCT 00338676）和 GENERAC（clinicalTrial.gov 编号 NCT 00647088）。
