Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
Department of Echocardiography, Royal Brompton Hospital, London, United Kingdom.
JACC Cardiovasc Imaging. 2017 Aug;10(8):912-920. doi: 10.1016/j.jcmg.2017.05.008.
The association of transaortic flow rate (FR) with outcomes was tested in 1,661 patients with aortic valve stenosis (AS) in the SEAS (Simvastatin and Ezetimibe in Aortic Stenosis) study.
Low transaortic flow may complicate grading of AS. However, the association of lower transaortic FR with adverse outcomes has not been reported.
Transaortic FR was calculated from Doppler-derived stroke volume in milliliters divided by systolic ejection time in seconds and considered low if <200 ml/s. The association of transaortic FR with cardiovascular and all-cause mortality during 4.3-year follow-up was tested in time-varying Cox regression models run with aortic valve replacement as competing risk and reported as hazard ratio (HR) and 95% confidence interval (CI).
Low transaortic FR was found in 21% of patients at baseline. Patients with low transaortic FR were older, had lower systemic arterial compliance and left ventricular mass, and included more women and patients with inconsistently graded severe AS and low stroke volume index (<35 ml/m) (p < 0.01 for all). Low in-study transaortic FR was associated with higher rates of cardiovascular and all-cause mortality both in unadjusted analyses (HR: 2.56 [95% CI: 1.62 to 4.04]; and HR: 1.93 [95% CI: 1.35 to 2.75], respectively; p < 0.001 for both) and after adjustment for age, sex, randomized study treatment, hypertension, stroke volume index <35 ml/m, LV mass, and mean aortic gradient (HR: 2.79 [95% CI: 1.65 to 4.73]; and HR: 1.90 [95% CI: 1.27 to 2.84], respectively; p < 0.01 for both).
In patients with AS without known cardiovascular disease or diabetes, low transaortic FR was independently associated with higher rates of cardiovascular and all-cause mortality. (An Investigational Drug on Clinical Outcomes in Patients With Aortic Stenosis (Narrowing of the Major Blood Vessel of the Heart) (MK-0653A-043 AM4); NCT00092677).
在主动脉瓣狭窄（AS）的 SEAS（辛伐他汀和依折麦布在主动脉瓣狭窄）研究中，对 1661 例患者的跨主动脉流量（FR）与结局的相关性进行了检测。
低跨主动脉流量可能使 AS 分级复杂化。然而，较低的跨主动脉 FR 与不良结局的相关性尚未报道。
从多普勒衍生的每搏量除以收缩期射血时间以毫升为单位计算跨主动脉 FR，如果<200 ml/s 则认为低。在 4.3 年的随访期间，使用主动脉瓣置换作为竞争风险的时变 Cox 回归模型测试跨主动脉 FR 与心血管和全因死亡率的相关性，并以危险比（HR）和 95%置信区间（CI）报告。
基线时有 21%的患者存在低跨主动脉 FR。低跨主动脉 FR 的患者年龄较大，全身动脉顺应性和左心室质量较低，包括更多的女性和不一致分级严重 AS 和低每搏量指数（<35 ml/m）的患者（所有 p<0.01）。在研究期间低跨主动脉 FR 与心血管和全因死亡率均较高，未调整分析（HR：2.56[95%CI：1.62 至 4.04]；HR：1.93[95%CI：1.35 至 2.75]）和调整年龄、性别、随机研究治疗、高血压、每搏量指数<35 ml/m、LV 质量和平均主动脉梯度后（HR：2.79[95%CI：1.65 至 4.73]；HR：1.90[95%CI：1.27 至 2.84]）。p<0.01）。
在无已知心血管疾病或糖尿病的 AS 患者中，低跨主动脉 FR 与较高的心血管和全因死亡率独立相关。（一项在主动脉瓣狭窄患者中评估临床结局的研究药物（心脏主要血管狭窄）（MK-0653A-043 AM4）；NCT00092677）。
