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主动脉瓣狭窄患者的收缩期高血压与主动脉瓣钙化进展：PROGRESSA研究结果

Systolic hypertension and progression of aortic valve calcification in patients with aortic stenosis: results from the PROGRESSA study.

作者信息

Tastet Lionel, Capoulade Romain, Clavel Marie-Annick, Larose Éric, Shen Mylène, Dahou Abdellaziz, Arsenault Marie, Mathieu Patrick, Bédard Élisabeth, Dumesnil Jean G, Tremblay Alexe, Bossé Yohan, Després Jean-Pierre, Pibarot Philippe

机构信息

Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Laval University, 2725 Chemin Sainte-Foy, Québec city, Québec, Canada G1V-4G5.

Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Laval University, 2725 Chemin Sainte-Foy, Québec city, Québec, Canada G1V-4G5

出版信息

Eur Heart J Cardiovasc Imaging. 2017 Jan;18(1):70-78. doi: 10.1093/ehjci/jew013. Epub 2016 Feb 18.

DOI:10.1093/ehjci/jew013
PMID:26896413
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5217738/
Abstract

AIMS: Hypertension is highly prevalent in patients with aortic stenosis (AS) and is associated with worse outcomes. The current prospective study assessed the impact of systolic hypertension (SHPT) on the progression of aortic valve calcification (AVC) measured by multidetector computed tomography (MDCT) in patients with AS. METHODS AND RESULTS: The present analysis includes the first series of 101 patients with AS prospectively recruited in the PROGRESSA study. Patients underwent comprehensive Doppler echocardiography and MDCT exams at baseline and after 2-year follow-up. AVC and coronary artery calcification (CAC) were measured using the Agatston method. Patients with SHPT at baseline (i.e. systolic blood pressure ≥140 mmHg; n = 37, 37%) had faster 2-year AVC progression compared with those without SHPT (i.e. systolic blood pressure <140 mmHg) (AVC median [25th percentile-75th percentile]: +370 [126-824] vs. +157 [58-303] AU; P = 0.007, respectively). Similar results were obtained with the analysis of AVC progression divided by the cross-sectional area of the aortic annulus (AVC: +96 [34-218] vs. +45 [14-82] AU/cm, P = 0.01, respectively). In multivariable analysis, SHPT remained significantly associated with faster progression of AVC or AVC (all P = 0.001). There was no significant difference between groups with respect to progression of CAC (+39 [3-199] vs. +41 [0-156] AU, P = 0.88). CONCLUSION: This prospective study shows for the first time that SHPT is associated with faster AVC progression but not with CAC progression in AS patients. These findings provide further support for the elaboration of randomized clinical trials to assess the efficacy of antihypertensive medication to slow the stenosis progression in patients with AS.

摘要

目的：高血压在主动脉瓣狭窄（AS）患者中极为常见，且与更差的预后相关。本前瞻性研究评估了收缩期高血压（SHPT）对AS患者经多排螺旋计算机断层扫描（MDCT）测量的主动脉瓣钙化（AVC）进展的影响。 方法与结果：本分析纳入了前瞻性招募到PROGRESSA研究中的首批101例AS患者。患者在基线和2年随访后接受了全面的多普勒超声心动图和MDCT检查。使用阿加斯顿方法测量AVC和冠状动脉钙化（CAC）。基线时患有SHPT的患者（即收缩压≥140 mmHg；n = 37，37%）与未患SHPT的患者（即收缩压<140 mmHg）相比，2年AVC进展更快（AVC中位数[第25百分位数 - 第75百分位数]：+370 [126 - 824] vs. +157 [58 - 303] AU；P = 0.007）。通过主动脉瓣环横截面积划分的AVC进展分析也得到了类似结果（AVC：+96 [34 - 218] vs. +45 [14 - 82] AU/cm，P = 0.01）。在多变量分析中，SHPT仍然与AVC或AVC的更快进展显著相关（所有P = 0.001）。两组在CAC进展方面无显著差异（+39 [3 - 199] vs. +41 [0 - 156] AU，P = 0.88）。 结论：这项前瞻性研究首次表明，SHPT与AS患者更快的AVC进展相关，但与CAC进展无关。这些发现为开展随机临床试验以评估抗高血压药物减缓AS患者狭窄进展的疗效提供了进一步支持。

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[2]
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J Geriatr Cardiol. 2025-3-28

[3]
[Impact of elevated arterial blood pressure on bioprosthetic valve calcification and failure after transcatheter aortic valve replacement].

Zhejiang Da Xue Xue Bao Yi Xue Ban. 2025-3-25

[4]
Inflammatory markers and calcification of coronary arteries, aorta and cardiac valves: Findings from the atherosclerosis risk in communities study.

Am J Prev Cardiol. 2025-2-8

[5]
Molecular Features of Calcific Aortic Stenosis in Female and Male Patients.

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[6]
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JACC Adv. 2024-9-11

[7]
Sex-Specific Functional Status Decline and Outcomes in Mild-to-Moderate Aortic Stenosis: Results From the PROGRESSA Study.

JACC Adv. 2024-9-6

[8]
Deficient GATA6-CXCR7 signaling leads to bicuspid aortic valve.

Dis Model Mech. 2024-9-1

[9]
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[10]
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本文引用的文献

[1]
Impact of statins on serial coronary calcification during atheroma progression and regression.

J Am Coll Cardiol. 2015-4-7

[2]
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Eur Heart J Cardiovasc Imaging. 2015-8

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Heart. 2015-2-5

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Impact of aortic valve calcification, as measured by MDCT, on survival in patients with aortic stenosis: results of an international registry study.

J Am Coll Cardiol. 2014-9-23

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Eur J Clin Invest. 2013-10-7

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The complex nature of discordant severe calcified aortic valve disease grading: new insights from combined Doppler echocardiographic and computed tomographic study.

J Am Coll Cardiol. 2013-9-24

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