Columbia University Medical Center, New York, New York; Cardiovascular Research Foundation, New York, New York; Hôpital du Sacré-Coeur de Montréal, Montréal, Canada.
Columbia University Medical Center, New York, New York; Cardiovascular Research Foundation, New York, New York.
J Am Coll Cardiol. 2016 May 17;67(19):2263-2288. doi: 10.1016/j.jacc.2016.02.057. Epub 2016 Apr 2.
Aortic stenosis (AS) is one of the most common valvular diseases encountered in clinical practice. Current guidelines recommend aortic valve replacement (AVR) when the aortic valve is severely stenotic and the patient is symptomatic; however, a substantial proportion of patients with severe AS are asymptomatic at the time of first diagnosis. Although specific morphological valve features, exercise testing, stress imaging, and biomarkers can help to identify patients with asymptomatic severe AS who may benefit from early AVR, the optimal management of these patients remains uncertain and controversial. The current report presents a comprehensive review of the natural history and the diagnostic evaluation of asymptomatic patients with severe AS, and is followed by a meta-analysis from reported studies comparing an early AVR strategy to active surveillance, with an emphasis on the level of evidence substantiating the current guideline recommendations. Finally, perspectives on directions for future investigation are discussed.
主动脉瓣狭窄（AS）是临床实践中最常见的瓣膜疾病之一。目前的指南建议在主动脉瓣严重狭窄且患者有症状时进行主动脉瓣置换（AVR）；然而，在首次诊断时，相当一部分严重 AS 患者无症状。尽管特定的形态瓣膜特征、运动试验、应激成像和生物标志物有助于识别可能从早期 AVR 中获益的无症状严重 AS 患者，但这些患者的最佳管理仍不确定且存在争议。本报告全面回顾了无症状严重 AS 患者的自然病史和诊断评估，并对报告的研究进行了荟萃分析，比较了早期 AVR 策略与积极监测的效果，重点是支持当前指南建议的证据水平。最后，讨论了未来研究方向的观点。
