Department of Cardiology, CIBERCV. University Alcala de Henares, Hospital Ramon y Cajal, Carretera de Colmenar Km 9.100, Madrid, Spain.
Cardiology Department, Hospital Universitario Vall d'Hebron, Passeig de la Vall d'Hebron, Barcelona, Spain.
Eur Heart J Cardiovasc Imaging. 2018 Oct 1;19(10):1142-1148. doi: 10.1093/ehjci/jex223.
Aortic stenosis (AS) is the most frequent valvular disease in developed countries. As society grows older, the prevalence of AS increases. However, the real burden, current aetiology, severity distribution, and echocardiographic patterns of AS are not fully clear. The aim of the present study is to provide an accurate overall picture of AS, focusing on its epidemiology, aetiology, and echocardiographic features.
A total of 29 502 consecutive echocardiograpies were prospectively included in this multicentre study. The present sample was composed of patients with advanced age (mean 75.2 years) and similar gender distribution. High proportion (7.2%) showed any grade of AS, with important number of patients (2.8%) presenting severe AS, most of them aged 75 years or more. Coexisting valvular disease appeared in almost half of the sample (49.6%), being the most frequently diagnosed aortic regurgitation (AR) (22%) followed by mitral regurgitation (MR) (15.6%). Degenerative aetiology was found in the vast majority (93.4%) of the studies whereas rheumatic is currently infrequent (3.35%). Low flow-low gradient (LFLG) appeared in 24.6% of patients with severe AS. Atrial fibrillation (23.1% vs. 11.6%; P = 0.002), MR (23.3% vs. 15.1%; P = 0.018), and right ventricle dysfunction (13.3% vs. 5.2%; P = 0.003) appeared frequently in LFLG group.
Burden of AS is higher than previously assumed. Degenerative aetiology is the main cause of AS. Most of the patients are elder with high prevalence of significant co-existing valvular disease. LFLG severe AS is present in an important proportion of patients, showing high grade of left ventricle remodelling.
主动脉瓣狭窄（AS）是发达国家最常见的瓣膜病。随着社会老龄化，AS 的患病率增加。然而，AS 的真实负担、当前病因、严重程度分布和超声心动图模式尚不完全清楚。本研究旨在全面准确地描述 AS，重点关注其流行病学、病因和超声心动图特征。
本项多中心前瞻性研究共纳入 29502 例连续超声心动图检查。本样本由高龄患者（平均年龄 75.2 岁）和相似性别分布组成。高比例（7.2%）显示任何程度的 AS，其中重要比例（2.8%）为严重 AS，大多数患者年龄在 75 岁或以上。将近一半的患者（49.6%）存在并存瓣膜病，最常见的诊断为主动脉瓣反流（AR）（22%），其次为二尖瓣反流（MR）（15.6%）。绝大多数研究（93.4%）发现退行性病因，而风湿性病因目前较为少见（3.35%）。严重 AS 患者中 24.6%存在低流量-低梯度（LFLG）。心房颤动（23.1%比 11.6%；P=0.002）、MR（23.3%比 15.1%；P=0.018）和右心室功能障碍（13.3%比 5.2%；P=0.003）在 LFLG 组中更为常见。
AS 的负担高于先前的估计。退行性病因是 AS 的主要原因。大多数患者年龄较大，伴有高比例的严重并存瓣膜病。LFLG 严重 AS 见于相当一部分患者，表现为左心室重构程度较高。
