Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
Department of Cardiac Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
JACC Cardiovasc Imaging. 2018 Aug;11(8):1072-1080. doi: 10.1016/j.jcmg.2018.04.019. Epub 2018 Jun 13.
The aim of this study was to study differences in progression of aortic stenosis (AS) in patients with mediastinal radiotherapy (XRT)-associated moderate AS versus a matched cohort during the same time frame, and to ascertain need for aortic valve replacement (AVR) and longer-term survival.
Rate of progression of XRT-associated moderate AS and its impact on outcomes is not well-described.
We included 81 patients (age 61 ± 13 years; 57% female) with at least XRT-associated moderate AS (aortic valve area [AVA] 1.05 ± 0.3 cm; mean gradient 24 ± 10 mm Hg) who had ≥2 transthoracic echocardiograms (TTEs) 1 year apart and matched them in a 1:2 fashion on the basis of age, sex, and AVA with those without prior XRT. Serial aortic valve gradients and AVA were recorded. AVR and longer-term all-cause mortality during follow-up were recorded.
A total of 100% of patients had 1, a total of 71% had 2, and 39% had 3 follow-up TTEs. Before AVR, mean AVG and AVA were not significantly different between XRT and comparison groups. At 3.6 ± 2.0 years from baseline TTE, 146 (60%) underwent AVR (16% transcatheter), with significantly more patients in the XRT group undergoing AVR (80% vs. 50%; p < 0.01), at a much shorter time (2.9 ± 1.6 years vs. 4.1 ± 2.4 years; p < 0.01). At 6.6 ± 4.0 years from the initial TTE, 49 (20%) patients died, with a significantly higher mortality in the XRT group (40% vs. 11%; p < 0.01), with prior XRT associated with increased longer-term mortality, whereas AVR was associated with improved longer-term survival.
In patients with moderate AS, those with prior XRT have a similar rate of progression of AS versus a comparison group. A higher proportion of patients in the XRT group were referred for AVR at a shorter time from baseline TTE. Despite that, the XRT patients had significantly higher longer-term mortality, and prior exposure to XRT was associated with significantly increased longer-term mortality.
本研究旨在比较纵隔放疗（XRT）相关中度主动脉瓣狭窄（AS）患者与同期匹配队列中 AS 进展的差异，并确定主动脉瓣置换（AVR）的必要性和长期生存率。
XRT 相关中度 AS 的进展速度及其对结局的影响尚不清楚。
我们纳入了 81 例至少有 XRT 相关中度 AS（主动脉瓣面积 [AVA] 1.05 ± 0.3 cm；平均梯度 24 ± 10 mmHg）的患者，这些患者在基线 TTE 后至少有 2 次 TTE，且 TTE 时间间隔为 1 年。根据年龄、性别和 AVA 将他们与没有 XRT 史的患者以 1:2 的比例进行匹配。记录连续的主动脉瓣梯度和 AVA。记录随访期间的 AVR 和长期全因死亡率。
共有 100%的患者完成了 1 次 TTE，71%的患者完成了 2 次，39%的患者完成了 3 次 TTE。在基线 TTE 后 3.6 ± 2.0 年，共有 146 例（60%）接受了 AVR（16%经导管），XRT 组患者接受 AVR 的比例明显更高（80%比 50%；p < 0.01），且时间更短（2.9 ± 1.6 年比 4.1 ± 2.4 年；p < 0.01）。在最初的 TTE 后 6.6 ± 4.0 年，共有 49 例（20%）患者死亡，XRT 组的死亡率明显更高（40%比 11%；p < 0.01），XRT 与长期死亡率增加相关，而 AVR 与长期生存率提高相关。
在中度 AS 患者中，XRT 相关中度 AS 患者与对照组相比，AS 的进展速度相似。XRT 组中更早接受 AVR 的患者比例更高。尽管如此，XRT 组患者的长期死亡率仍然明显更高，且 XRT 暴露与长期死亡率增加显著相关。
