Department of Cardiology, Ramón y Cajal University Hospital, CIBERCV, Madrid, Spain.
Department of Cardiology, Ramón y Cajal University Hospital, CIBERCV, Madrid, Spain.
Int J Cardiol. 2017 Dec 1;248:211-215. doi: 10.1016/j.ijcard.2017.06.064. Epub 2017 Aug 30.
Clinicians often encounter patients with apparently discordant echocardiographic findings, severe aortic stenosis (SAS) defined by aortic valve area (AVA) despite a low mean gradient. A new classification according to flow state and pressure gradient has been proposed. We sought to assess the prevalence, characteristics and outcomes of patients with asymptomatic SAS with preserved left-ventricular ejection fraction (LVEF) according to flow and gradient.
In total 442 patients with SAS (AVAi<0.6 cm2/m2) and LVEF ≥50% (mean age 80+11years, 54,5% female) were included. Patients were classified according to flow state (≥ or <35ml/m) and mean pressure gradient (≥ or <40mmHg): Low Flow/Low Gradient (LF/LG): 21.3%(n=94); Normal Flow/Low Gradient (NF/LG): 32.1%(n=142); Low Flow/High Gradient (LF/HG): 6.8%(n=30); Normal Flow/High Gradient (NF/HG): 39,8%(n=176). Mean follow-up time was 20.5months (SD=10.3). Primary combined endpoint was cardiovascular mortality and hospital admission for SAS related symptom, secondary endpoint was aortic valve replacement (AVR), comparing HG group to LF/LG group. During follow-up 17 (18%) of LF/LG patients and 21 (10.2%) of HG patients met the primary endpoint. A lower free of event survival (cardiovascular mortality and hospital admission) was observed in patients with LF/LG AS (Breslow, p=0.002). Significant differences were noted between groups with a lower AVR free survival in the LF/LG group compared to HG groups (Breslow, p=0.002).
Our study confirms the high prevalence and worse prognosis of LF/LG SAS. Clinicians must be aware of this entity to ensure appropriate patient management.
临床医生经常会遇到心脏超声检查结果明显不一致的患者，尽管主动脉瓣面积（AVA）严重狭窄（SAS），但平均梯度较低。已经提出了一种根据血流状态和压力梯度的新分类。我们试图根据血流和梯度评估左心室射血分数（LVEF）保留的无症状 SAS 患者的患病率、特征和结局。
共纳入 442 名 SAS 患者（AVAi<0.6 cm2/m2）和 LVEF≥50%（平均年龄 80+11 岁，54.5%为女性）。根据血流状态（≥或<35ml/m）和平均压力梯度（≥或<40mmHg）对患者进行分类：低流量/低梯度（LF/LG）：21.3%（n=94）；正常流量/低梯度（NF/LG）：32.1%（n=142）；低流量/高梯度（LF/HG）：6.8%（n=30）；正常流量/高梯度（NF/HG）：39.8%（n=176）。平均随访时间为 20.5 个月（SD=10.3）。主要复合终点是心血管死亡率和因 SAS 相关症状住院，次要终点是主动脉瓣置换（AVR），将 HG 组与 LF/LG 组进行比较。随访期间，LF/LG 组中有 17 名（18%）患者和 HG 组中有 21 名（10.2%）患者达到主要终点。LF/LG AS 患者无事件生存率（心血管死亡率和住院）较低（Breslow，p=0.002）。在 LF/LG 组中，与 HG 组相比，AVR 无生存差异具有统计学意义（Breslow，p=0.002）。
我们的研究证实了 LF/LG SAS 的高患病率和更差的预后。临床医生必须意识到这一实体，以确保对患者进行适当的管理。
