Ledwoch J, Thiele H
Medical Clinic II (Medical Clinic II, Department of Cardiology, Angiology, Intensive Care Medicine), University Heart Center Lübeck, Universitätsklinikum Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Germany.
Partner Site Hamburg/Kiel/Lübeck, German Center for Cardiovascular Research (DZHK), Lübeck, Germany.
Herz. 2017 Sep;42(6):528-535. doi: 10.1007/s00059-017-4584-z.
There is ongoing debate about the optimal management of severe asymptomatic aortic stenosis (AS). Thus far, current guidelines recommend a watchful waiting strategy for the majority of asymptomatic patients. However, data on the prognosis of asymptomatic AS are inconsistent. Some reports claim an increased risk of complications and even mortality in this subset of patients when treated conservatively. Several factors are considered to contribute to the impaired outcome of asymptomatic patients, such as progressive myocardial damage or sudden cardiac death, during the watchful waiting period. Indeed, a few nonrandomized studies are available in the literature showing improved survival with early aortic valve replacement during the asymptomatic phase compared with watchful waiting. However, these studies have several limitations particularly with regard to methodology, and thus making a clear recommendation on treatment options impossible. Therefore, randomized controlled trials are urgently needed in order to treat these patients on the basis of adequate evidence.
关于重度无症状主动脉瓣狭窄（AS）的最佳管理方案，目前仍存在争议。到目前为止，现行指南建议对大多数无症状患者采取密切观察等待策略。然而，无症状AS患者预后的数据并不一致。一些报告称，对这部分患者进行保守治疗时，并发症风险甚至死亡率会增加。在密切观察等待期间，有几个因素被认为会导致无症状患者预后受损，比如进行性心肌损伤或心源性猝死。事实上，文献中有一些非随机研究表明，与密切观察等待相比，在无症状阶段早期进行主动脉瓣置换可提高生存率。然而，这些研究存在一些局限性，尤其是在方法学方面，因此无法就治疗方案给出明确建议。所以，迫切需要进行随机对照试验，以便在充分证据的基础上对这些患者进行治疗。
