Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands.
Department of Cardiology, Quebec Heart and Lung Institute/Laval University, Quebec City, Quebec, Canada.
J Am Coll Cardiol. 2017 May 16;69(19):2383-2392. doi: 10.1016/j.jacc.2017.03.023.
Left ventricular (LV) systolic dysfunction and moderate aortic stenosis (AS) are more frequent with advancing age and often coexist. Afterload reduction is the mainstay of pharmacological treatment of heart failure (HF). Aortic valve replacement (AVR) is only formally indicated for symptomatic severe AS.
This study sought to determine the clinical outcome of patients with concomitant moderate AS and LV systolic dysfunction.
Echocardiographic and clinical data of patients with moderate AS and LV systolic dysfunction between 2010 and 2015 from 4 large academic institutions were retrospectively analyzed. Moderate AS was defined as aortic valve area between 1.0 and 1.5 cm and LV systolic dysfunction defined as LV ejection fraction <50%. The primary endpoint was a composite of all-cause death, AVR, and HF hospitalization.
A total of 305 patients (mean age 73 ± 11 years; 75% male) were included. The majority were symptomatic at the time of index echocardiogram (New York Heart Association [NYHA] functional class II: 42%; NYHA functional class III: 28%; and NYHA functional class IV: 4%). Ischemic heart disease was present in 72% of patients. At 4-year follow-up, the primary composite endpoint occurred in 61%. The main predictors for the primary endpoint were male sex (p = 0.022), NYHA functional class III or IV (p < 0.001), and peak aortic jet velocity (p < 0.001). The rate of the composite of all-cause death or HF hospitalization was 48%, rate of all-cause death was 36%, and rate of HF hospitalization was 27%. AVR occurred in 24% of patients.
Patients with concomitant moderate AS and LV systolic dysfunction are at high risk for clinical events. Further studies are needed to determine if earlier AVR in these patients might improve clinical outcome.
左心室（LV）收缩功能障碍和中度主动脉瓣狭窄（AS）随着年龄的增长更为常见，且常并存。减轻后负荷是心力衰竭（HF）药物治疗的主要方法。主动脉瓣置换术（AVR）仅对有症状的严重 AS 正式适用。
本研究旨在确定伴有中度 AS 和 LV 收缩功能障碍的患者的临床结局。
回顾性分析了 2010 年至 2015 年 4 家大型学术机构中伴有中度 AS 和 LV 收缩功能障碍的患者的超声心动图和临床数据。中度 AS 定义为主动脉瓣口面积为 1.0 至 1.5 cm，LV 收缩功能障碍定义为 LV 射血分数 <50%。主要终点是全因死亡、AVR 和 HF 住院的复合终点。
共纳入 305 例患者（平均年龄 73 ± 11 岁，75%为男性）。大多数患者在进行首次超声心动图检查时出现症状（纽约心脏协会[NYHA]心功能分级 II：42%；NYHA 心功能分级 III：28%；NYHA 心功能分级 IV：4%）。72%的患者存在缺血性心脏病。在 4 年的随访中，主要复合终点发生在 61%的患者中。主要预测因素为男性（p = 0.022）、NYHA 心功能分级 III 或 IV（p < 0.001）和峰值主动脉瓣口射流速度（p < 0.001）。全因死亡或 HF 住院的复合终点发生率为 48%，全因死亡率为 36%，HF 住院率为 27%。24%的患者接受了 AVR。
伴有中度 AS 和 LV 收缩功能障碍的患者发生临床事件的风险较高。需要进一步研究确定这些患者是否更早进行 AVR 可能会改善临床结局。
