Division of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA.
Eur Heart J Cardiovasc Imaging. 2018 Jun 1;19(6):668-674. doi: 10.1093/ehjci/jex148.
Determine the role of diastolic function indices in pre-operative and post-operative risk stratification in patients with moderate mixed aortic valve disease (MAVD).
A retrospective study was conducted of asymptomatic patients with moderate MAVD (a combination of moderate aortic stenosis and moderate aortic regurgitation) and an ejection fraction of 50% or more who were followed up at Mayo Clinic from 1 January 2004, to 31 December 2013. A pre-requisite for inclusion in the study was assessment of diastolic function involving at least three of the following indices: tissue Doppler early diastolic velocity (e'), mitral inflow early velocity (E), tricuspid regurgitation velocity, and left atrial volume index. Primary endpoints were aortic valve replacement (AVR) or cardiac death while secondary endpoints were cardiovascular adverse events (CAEs) after AVR. We defined CAEs as stroke, heart failure hospitalization, severe left ventricular dysfunction, and cardiac death. There were 214 patients (age 61 ± 8 years, men 146 [68%]) followed for 6.1 ± 2.3 years during which 162 (76%) AVRs and 11 (5%) cardiac deaths occurred. The multivariable risk factors for cardiac death or AVR were relative wall thickness (RWT) > 0.42 [hazard ratio (HR), 1.88 [95% CI, 1.28-2.59]; P = 0.001] and average E/e' >14 (HR, 1.94 [95% CI, 1.29-3.01]; P = 0.02). Freedom from CAE after AVR was significantly lower in the patients with baseline RWT >0.42 or mean E/e' >14 than the other patients: 79% (95% CI 74-83%) vs. 94% (95% CI 89-98%) at 3 years (P = 0.03).
The presence of RWT >0.42 or E/e' >14 identifies a high-risk patient subset whose risk for cardiovascular morbidities persists even after AVR.
确定舒张功能指数在中度混合性主动脉瓣疾病（MAVD）患者术前和术后风险分层中的作用。
这是一项回顾性研究，纳入了 2004 年 1 月 1 日至 2013 年 12 月 31 日期间在梅奥诊所接受随访的无症状中度 MAVD（主动脉瓣狭窄和主动脉瓣反流合并中度病变）且射血分数≥50%的患者。研究纳入的前提条件是评估舒张功能，包括以下至少三个指数：组织多普勒早期舒张速度（e'）、二尖瓣血流早期速度（E）、三尖瓣反流速度和左心房容积指数。主要终点为主动脉瓣置换（AVR）或心脏死亡，次要终点为 AVR 后的心血管不良事件（CAE）。我们将 CAE 定义为卒中、心力衰竭住院、严重左心室功能障碍和心脏死亡。共有 214 例患者（年龄 61±8 岁，男性 146 例[68%]）接受了 6.1±2.3 年的随访，其中 162 例（76%）接受了 AVR，11 例（5%）心脏死亡。心脏死亡或 AVR 的多变量危险因素为相对壁厚度（RWT）＞0.42[风险比（HR），1.88[95%可信区间（CI），1.28-2.59]；P=0.001]和平均 E/e'＞14（HR，1.94[95% CI，1.29-3.01]；P=0.02）。与其他患者相比，基线 RWT＞0.42 或平均 E/e'＞14 的患者 AVR 后发生 CAE 的风险明显更低：3 年时分别为 79%（95% CI，74-83%）和 94%（95% CI，89-98%）（P=0.03）。
RWT＞0.42 或 E/e'＞14 表明存在高危亚组患者，即使在 AVR 后，其心血管不良事件的风险仍然持续存在。
