Zilberszac Robert, Lancellotti Patrizio, Gilon Dan, Gabriel Harald, Schemper Michael, Maurer Gerald, Massetti Massimo, Rosenhek Raphael
Department of Cardiology, Vienna General Hospital, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
Department of Cardiology, Heart Valve Clinic, GIGA Cardiovascular Sciences, University of Liège Hospital, CHU Sart Tilman, Liège, Belgium.
Eur Heart J Cardiovasc Imaging. 2017 Feb;18(2):138-144. doi: 10.1093/ehjci/jew133. Epub 2016 Aug 12.
We sought to assess the efficacy of a heart valve clinic (HVC) follow-up programme for patients with severe aortic stenosis (AS).
Three hundred and eighty-eight consecutive patients with AS (age 71 ± 10 years; aortic-jet velocity 5.1 ± 0.6 m/s) and an indication for aortic valve replacement (AVR) were included. Of these, 290 patients presented with an indication for surgery at their first visit at the HVC and 98 asymptomatic patients who had been enrolled in an HVC monitoring programme developed indications for surgery during follow-up. Time to symptom detection was significantly longer in patients that presented with symptoms at baseline (352 ± 471 days) than in patients followed in the HVC (76 ± 75 days, P < 0.001). Despite being educated to recognize and promptly report new symptoms, 77 of the 98 patients in the HVC programme waited until the next scheduled consultation to report them. Severe symptom onset (NYHA or CCS Class ≥III) was present in 61% of patients being symptomatic at the initial visit and in 34% of patients in the HVC programme (P < 0.001).
Delays in referral and symptom reporting as well as symptom denial are common in patients with AS. These findings support the concept of risk stratification to identify patients who may benefit from elective surgery. A structured HVC programme results in the detection of symptoms at an earlier and less severe stage and thus in an optimized timing of surgery.
我们旨在评估心脏瓣膜诊所（HVC）随访计划对重度主动脉瓣狭窄（AS）患者的疗效。
纳入388例连续的AS患者（年龄71±10岁；主动脉射流速度5.1±0.6m/s），且均有主动脉瓣置换术（AVR）指征。其中，290例患者在首次就诊于HVC时就有手术指征，98例无症状患者纳入HVC监测计划，在随访期间出现了手术指征。基线时有症状的患者出现症状的时间（352±471天）明显长于在HVC随访的患者（76±75天，P<0.001）。尽管接受了识别和及时报告新症状的教育，但HVC计划中的98例患者中有77例等到下次预定会诊时才报告症状。初次就诊时有症状的患者中61%出现严重症状发作（纽约心脏协会或加拿大心血管学会分级≥III级），HVC计划中的患者为34%（P<0.001）。
AS患者转诊延迟、症状报告延迟以及症状否认很常见。这些发现支持风险分层的概念，以识别可能从择期手术中获益的患者。结构化的HVC计划可在更早且症状较轻的阶段发现症状，从而优化手术时机。
