Clavel Marie-Annick, Côté Nancy, Pibarot Philippe
Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec City, Québec, Canada.
Curr Opin Cardiol. 2017 Mar;32(2):147-151. doi: 10.1097/HCO.0000000000000374.
Grading of aortic stenosis is essential in aortic stenosis management patients. However, despite clear thresholds provided in the guidelines, up to 30% of patients have discordant grading of aortic stenosis. The management of patients with low gradients/velocity despite tight aortic valve area is challenging.
Recent studies demonstrated that patients with or without low flow may have a severe aortic stenosis despite a low gradient. Moreover, aortic valve replacement has been shown to improve outcome in low-gradient aortic stenosis patients with or without low flow. Finally, measurement of aortic valve calcification by multidetector computed tomography is an important tool to assess aortic stenosis severity in these patients.
The presence of a low gradient/velocity despite a tight aortic valve area could be linked to low ejection fraction or low flow with preserved ejection fraction but also with normal flow and normal ejection fraction. In each situation, aortic stenosis could be truly severe or pseudosevere, and the severity of aortic stenosis has to be accurately evaluated for clinical decision-making. Nowadays, two types of interventions are available: surgical and transcatheter aortic valve replacement, whereas conservative management should be considered as a palliative treatment in patients with proven severe aortic stenosis and symptoms or left ventricle dysfunction.
主动脉瓣狭窄的分级对于主动脉瓣狭窄患者的管理至关重要。然而，尽管指南提供了明确的阈值，但仍有高达30%的患者主动脉瓣狭窄分级不一致。对于主动脉瓣口面积狭窄但梯度/流速较低的患者的管理具有挑战性。
最近的研究表明，无论有无低流量，梯度较低的患者可能存在严重的主动脉瓣狭窄。此外，已证明主动脉瓣置换术可改善有或无低流量的低梯度主动脉瓣狭窄患者的预后。最后，通过多排螺旋计算机断层扫描测量主动脉瓣钙化是评估这些患者主动脉瓣狭窄严重程度的重要工具。
尽管主动脉瓣口面积狭窄，但梯度/流速较低可能与射血分数降低或射血分数正常但流量较低有关，也可能与流量正常和射血分数正常有关。在每种情况下，主动脉瓣狭窄可能是真正的严重狭窄或假性严重狭窄，为了临床决策，必须准确评估主动脉瓣狭窄的严重程度。如今，有两种类型的干预措施：外科手术和经导管主动脉瓣置换术，而对于已证实有严重主动脉瓣狭窄且有症状或左心室功能障碍的患者，保守治疗应被视为一种姑息治疗。
