Department of Cardiovascular Center, Osaka Red Cross Hospital.
Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine.
Circ J. 2018 Feb 23;82(3):874-885. doi: 10.1253/circj.CJ-17-0610. Epub 2017 Oct 27.
Clinical profiles of acute heart failure (AHF) complicating severe aortic stenosis (AS) remain unclear.Methods and Results:From a Japanese multicenter registry enrolling consecutive patients with severe AS, 3,813 patients were categorized into the 3 groups according to the symptom of heart failure (HF); No HF (n=2,210), chronic HF (CHF) (n=813) and AHF defined as hospitalized HF at enrolment (n=790). Median follow-up was 1,123 days with 93% follow-up rate at 2 years. Risk factors for developing AHF included age, female sex, lower body mass index, untreated coronary artery stenosis, anemia, history of HF, left ventricular ejection fraction <50%, presence of any combined valvular disease, peak aortic jet velocity ≥5 m/s and tricuspid regurgitation pressure gradient ≥40 mmHg, and negative risk factors included dyslipidemia, history of percutaneous coronary intervention and hemodialysis. Respective cumulative 5-year incidences of all-cause death and HF hospitalization in No HF, CHF and AHF groups were 37.1%, 41.8% and 61.8% (P<0.001) and 20.7%, 33.8% and 52.3% (P<0.001). Even in the initial aortic valve replacement (AVR) stratum, AHF was associated with excess 5-year mortality risk relative to No HF and CHF (adjusted hazard ratio [HR] 1.64; 95% confidence interval [CI]: 1.14-2.36, P=0.008; adjusted HR 1.47; 95% CI: 1.03-2.11, P=0.03, respectively).
AHF complicating severe AS was associated with an extremely dismal prognosis, which could not be fully resolved by AVR. Careful management to avoid the development of AHF is crucial.
急性心力衰竭（AHF）合并严重主动脉瓣狭窄（AS）的临床特征尚不清楚。
从日本多中心注册登记连续纳入的严重 AS 患者中，根据心力衰竭（HF）症状将 3813 例患者分为 3 组；无 HF（n=2210）、慢性 HF（CHF）（n=813）和 AHF（定义为登记时住院 HF）（n=790）。中位随访时间为 1123 天，2 年随访率为 93%。发生 AHF 的危险因素包括年龄、女性、较低的体重指数、未经治疗的冠状动脉狭窄、贫血、HF 病史、左心室射血分数<50%、存在任何合并瓣膜病、峰值主动脉射流速度≥5 m/s 和三尖瓣反流压力梯度≥40 mmHg，而负危险因素包括血脂异常、经皮冠状动脉介入治疗史和血液透析。无 HF、CHF 和 AHF 组的全因死亡和 HF 住院的 5 年累积发生率分别为 37.1%、41.8%和 61.8%（P<0.001）和 20.7%、33.8%和 52.3%（P<0.001）。即使在初始主动脉瓣置换（AVR）分层中，与无 HF 和 CHF 相比，AHF 与 5 年死亡风险增加相关（调整后的危险比[HR] 1.64；95%置信区间[CI]：1.14-2.36，P=0.008；调整后的 HR 1.47；95% CI：1.03-2.11，P=0.03）。
严重 AS 合并 AHF 预后极差，AVR 不能完全解决。需要仔细管理以避免 AHF 的发生。
