Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan.
J Am Heart Assoc. 2018 May 18;7(11):e008397. doi: 10.1161/JAHA.117.008397.
The annual incidence of sudden death has been reported to be low (<1%/year) in asymptomatic patients with severe aortic stenosis (AS), and there is a paucity of data on the risk factors of sudden death in patients with severe AS.
We evaluated the incidence and risk factors of sudden death during the median follow-up period of 1334 days in the Contemporary Outcomes After Surgery and Medical Treatment in Patients With Severe Aortic Stenosis (CURRENT AS) registry enrolling 3815 consecutive patients with severe AS between 2003 and 2011. The mean age was 78 years, and the prevalences of male sex and prior myocardial infarction were 38% and 8%, respectively. Sudden death occurred in 175 patients without aortic valve replacement. The cumulative 5-year incidences of sudden death, censored at aortic valve replacement, which accounted for the competing risk, were 9.2% in symptomatic patients and 7.2% (1.4%/year) in asymptomatic patients (<0.001). Among 82 asymptomatic patients experiencing sudden death, 54 patients (66%) died abruptly without any preceding symptoms, and 35 (65%) of these sudden deaths occurred within 3 months of the last clinical follow-up visit. Independent risk factors for sudden death were hemodialysis (hazard ratio [HR] 3.63; 95% confidence interval [CI] 2.42-5.43), prior myocardial infarction (HR 2.11; 95% CI 1.28-3.50), body mass index <22 (HR 1.51; 95% CI 1.03-2.21), peak aortic jet velocity ≥5 m/s (HR 1.76; 95% CI 1.12-2.78), and left ventricular ejection fraction <60% (HR 1.52; 95% CI 1.08-2.14).
The incidence of sudden death in asymptomatic patients with severe AS might be higher than that reported in previous reports. Several baseline clinical and echocardiographic characteristics were associated with increased risk of sudden death.
URL: www.umin.ac.jp/ctr/index.htm. Unique identifier: UMIN000012140.
据报道，无症状重度主动脉瓣狭窄（AS）患者的猝死发生率较低（<1%/年），且关于重度 AS 患者猝死风险因素的数据较少。
我们评估了 2003 年至 2011 年间连续 3815 例重度 AS 患者的当代重度主动脉瓣狭窄患者手术后和药物治疗的结果（CURRENT AS）登记研究中，在中位随访 1334 天期间的猝死发生率和风险因素。平均年龄为 78 岁，男性和既往心肌梗死的患病率分别为 38%和 8%。未经主动脉瓣置换术的 175 例患者发生猝死。经主动脉瓣置换术（占竞争风险）校正后，5 年累计猝死发生率在有症状患者中为 9.2%，在无症状患者中为 7.2%（1.4%/年）（<0.001）。在 82 例无症状猝死患者中，54 例（66%）猝死患者无任何前驱症状，其中 35 例（65%）猝死发生在最后一次临床随访后 3 个月内。猝死的独立危险因素是血液透析（风险比[HR]3.63；95%置信区间[CI]2.42-5.43）、既往心肌梗死（HR 2.11；95%CI 1.28-3.50）、体重指数<22（HR 1.51；95%CI 1.03-2.21）、峰值主动脉射流速度≥5m/s（HR 1.76；95%CI 1.12-2.78）和左心室射血分数<60%（HR 1.52；95%CI 1.08-2.14）。
无症状重度 AS 患者的猝死发生率可能高于既往报告。一些基线临床和超声心动图特征与猝死风险增加相关。
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