Division of Cardiology - ACC Building 5th floor, University of Florida College of Medicine - Jacksonville, 655 West 8th Street, Jacksonville, FL, 32209, USA.
Division of Cardiology, Duke University Hospital, Durham, NC, USA.
Curr Cardiol Rep. 2018 Oct 11;20(12):129. doi: 10.1007/s11886-018-1072-x.
The optimal treatment for asymptomatic patients with severe aortic valve stenosis (AS) is not clearly known. Here, we review the available data on the management of such patients.
Half of patients with severe AS are asymptomatic at the time of diagnosis, and are at risk for adverse events, including sudden cardiac death. A significant proportion of these patients develop AS-related symptoms within 1 or 2 years. Clinical and echocardiographic characteristics are predictors of poor outcomes and can guide treatment decisions. Several non-randomized studies and meta-analyses have suggested benefit from early AVR for asymptomatic severe AS, including improved all-cause, cardiovascular, and valve-related mortality. Based on the available information, current guidelines suggest aortic valve replacement in the presence of specific characteristic, including left ventricular dysfunction and very severe AS with significantly elevated gradients. Although the available data suggests early AVR improves the clinical outcomes of these patients, most patients in current practice are managed conservatively. Six randomized trials are ongoing to better elucidate the ideal management of asymptomatic severe AS patients.
目前尚不清楚无症状重度主动脉瓣狭窄（AS）患者的最佳治疗方法。本文对无症状重度 AS 患者的处理方法进行了综述。
一半的重度 AS 患者在诊断时无症状，但有发生不良事件的风险，包括心源性猝死。这些患者中有相当一部分在 1 至 2 年内会出现 AS 相关症状。临床和超声心动图特征是预后不良的预测因素，可指导治疗决策。一些非随机研究和荟萃分析表明，无症状重度 AS 患者行主动脉瓣置换术（AVR）有益，包括全因死亡率、心血管死亡率和瓣膜相关死亡率的降低。基于现有信息，目前的指南建议在存在特定特征时行主动脉瓣置换术，包括左心室功能障碍和严重的瓣上狭窄伴明显升高的压力梯度。尽管现有数据表明早期 AVR 可改善这些患者的临床结局，但目前大多数患者仍接受保守治疗。有 6 项随机试验正在进行中，以更好地阐明无症状重度 AS 患者的理想治疗方法。
