Service Cardiologie, CHU Limoges, Hôpital Dupuytren, Limoges, 87042, France.
INSERM 1094, Faculté de médecine de Limoges, 2, rue Marcland, Limoges, 87000, France.
Clin Res Cardiol. 2017 Jul;106(7):542-550. doi: 10.1007/s00392-017-1085-2. Epub 2017 Feb 14.
The prognostic impact of elevated pulmonary arterial pressure (PAP) remains controversial in aortic stenosis (AS) and few studies focused on patients with preserved left ventricular ejection fraction (LVEF). We aimed to investigate the impact of pulmonary hypertension (PH), invasively derived, on survival in severe AS with preserved LVEF.
Between 2000 and 2010, 749 patients (74 ± 8 years, 57% males) with preserved LVEF and severe AS without other valvular heart disease underwent cardiac catheterization. PH was defined as mean PAP > 25 mmHg. The mean follow-up was 4.6 ± 3.0 years. Overall, 32% (n = 241) of patients had PH. Surgical aortic valve replacement (SAVR) was performed in 91% of patients with 4.5% of 30-day mortality rate, significantly higher in patients with PH than without PH (7.5 vs. 3.5%, p = 0.014). In logistic regression, PH was an independent predictor of increased 30-day mortality (odds-ratio = 2.2, p = 0.04). Overall long-term survival was significantly reduced in patients with PH as compared to those without (10-year: 52 ± 5 vs. 68 ± 3%, p < 0.0001). Likewise, focusing on patients with SAVR showed significant reduced survival in those with PH (10-year: 57 ± 5 vs. 72 ± 3%, p < 0.0001). In multivariate analysis, after adjustment for relevant cofactors, PH was an independent predictor of mortality (hazard ratio = 1.5, p = 0.009). Using quartiles of mean PAP, only patients with most elevated values (Q4: mean PAP: 27-67mmHg) had significantly reduced survival, as compared to other quartiles (all p < 0.0001).
In patients with severe AS and preserved LVEF, PH is an independent predictor of 30-day and long-term mortality patients. Nevertheless, only severely elevated PAP seems associated with reduced survival.
肺动脉高压（PAP）对主动脉瓣狭窄（AS）患者预后的影响仍存在争议，很少有研究关注左心室射血分数（LVEF）保留的患者。本研究旨在探讨经导管测量的肺动脉高压（PH）对射血分数保留的重度 AS 患者生存的影响。
2000 年至 2010 年，749 例 LVEF 保留且无其他瓣膜性心脏病的重度 AS 患者（74±8 岁，57%为男性）接受了心导管检查。PH 定义为平均 PAP＞25mmHg。平均随访时间为 4.6±3.0 年。总体而言，32%（n=241）的患者存在 PH。91%的患者接受了主动脉瓣置换术（SAVR），30 天死亡率为 4.5%，PH 患者显著高于无 PH 患者（7.5% vs. 3.5%，p=0.014）。多因素 logistic 回归分析显示，PH 是 30 天死亡率增加的独立预测因素（比值比=2.2，p=0.04）。与无 PH 患者相比，PH 患者的总体长期生存率显著降低（10 年：52±5% vs. 68±3%，p＜0.0001）。同样，在接受 SAVR 的患者中，PH 患者的生存率也显著降低（10 年：57±5% vs. 72±3%，p＜0.0001）。多因素分析显示，在调整相关协变量后，PH 是死亡率的独立预测因素（风险比=1.5，p=0.009）。使用平均 PAP 的四分位数，仅 Q4（平均 PAP：27-67mmHg）患者的生存率显著降低，与其他四分位数相比（均 p＜0.0001）。
在 LVEF 保留的重度 AS 患者中，PH 是 30 天和长期死亡率的独立预测因素。然而，只有严重升高的 PAP 与生存率降低相关。
