Lønnebakken Mai Tone, De Simone Giovanni, Saeed Sahrai, Boman Kurt, Rossebø Anne B, Bahlmann Edda, Gohlke-Bärwolf Christa, Gerdts Eva
Department of Clinical Science, University of Bergen, Bergen, Norway.
Department of Translational Medical Science, Hypertension Research Center, Federico II University Hospital, Naples, Italy.
Heart. 2017 Sep;103(18):1443-1448. doi: 10.1136/heartjnl-2016-310917. Epub 2017 Apr 28.
In severe aortic valve stenosis (AS), low left ventricular (LV) stroke volume has been associated with increased cardiovascular (CV) mortality, but this association has not been explored during progression of AS in a large prospective study.
In 1671 patients from the Simvastatin Ezetimibe in Aortic Stenosis (SEAS) study, the association of stroke volume indexed for body surface area (SVI) with major CV events during a median of 4.3-year follow-up was assessed in Cox and time-varying Cox regression analyses. Low SVI was defined as <35 mL/m.
Peak aortic jet velocity in the total study population was 3.1 ±0.7 m/s. Low SVI was found in 23% at baseline and associated with higher age, body mass index (BMI), heart rate and global LV load, and with lower mean aortic gradient, aortic valve area index, energy loss index, LV mass and ejection fraction and more often inconsistent AS grading (all p<0.05). A 5 mL/m lower SVI at baseline was associated with higher HRs of major CV events (n=544) (HR 1.09, 95% CI 1.05 to 1.13, p<0.001) and higher total mortality (n=147) (HR 1.08, 95% CI 1.01 to 1.16, p=0.038), independent of age, sex, atrial fibrillation, mean aortic gradient, LV ejection fraction, LV mass, BMI and study treatment. Adjusting for the same covariates, low SVI at baseline and in-study low SVI were also associated with increased rate of major CV events.
In patients with AS in the SEAS study, lower baseline SVI was associated with higher HR of major CV events and total mortality independent of major confounders.
NCT00092677: Results.
在重度主动脉瓣狭窄（AS）中，左心室（LV）每搏量降低与心血管（CV）死亡率增加相关，但在一项大型前瞻性研究中，尚未在AS进展过程中探究这种关联。
在主动脉瓣狭窄辛伐他汀依折麦布研究（SEAS）的1671例患者中，在中位4.3年的随访期间，采用Cox回归和时变Cox回归分析评估体表面积指数化每搏量（SVI）与主要CV事件之间的关联。低SVI定义为<35 mL/m²。
整个研究人群的主动脉峰值射流速度为3.1±0.7 m/s。基线时23%的患者存在低SVI，且与年龄较大、体重指数（BMI）、心率和整体左心室负荷较高相关，与平均主动脉压力阶差较低、主动脉瓣面积指数、能量损失指数、左心室质量和射血分数较低以及更常出现的AS分级不一致相关（均p<0.05）。基线时SVI每降低5 mL/m²与主要CV事件（n=544）的较高风险（HR 1.09，95%CI 1.05至1.13，p<0.001）和较高的总死亡率（n=147）（HR 1.08，95%CI 1.01至1.16，p=0.038）相关，独立于年龄、性别、心房颤动、平均主动脉压力阶差、左心室射血分数、左心室质量、BMI和研究治疗。调整相同的协变量后，基线时的低SVI和研究期间的低SVI也与主要CV事件发生率增加相关。
在SEAS研究的AS患者中，较低的基线SVI与主要CV事件和总死亡率的较高风险相关，独立于主要混杂因素。
NCT00092677：结果。
