Department of Clinical Science, University of Bergen, Bergen, Norway.
Department of Heart Disease, Haukeland Universitetssjukehus, Bergen, Norway.
Heart. 2019 Nov;105(21):1629-1633. doi: 10.1136/heartjnl-2018-314462. Epub 2019 Jun 1.
Whether increased myocardial oxygen demand could help explain the association of left ventricular (LV) hypertrophy with higher adverse event rate in patients with aortic valve stenosis (AS) is unknown.
Data from 1522 patients with asymptomatic mostly moderate AS participating in the Simvastatin-Ezetimibe in AS study followed for a median of 4.3 years was used. High LV mass-wall stress-heart rate product was identified as >upper 95% CI limit in normal subjects. The association of higher LV mass-wall stress-heart rate product with major cardiovascular (CV) events, combined CV death and hospitalised heart failure and all-cause mortality was tested in Cox regression analyses, and reported as HR and 95% CI.
High LV mass-wall stress-heart rate product was found in 19% at baseline, and associated with male sex, higher body mass index, hypertension, LV hypertrophy, more severe AS and lower LV ejection fraction (all p<0.01). Adjusting for these confounders in time-varying Cox regression analysis, 1 SD higher LV mass-wall stress-heart rate product was associated with higher HR of major CV events (HR 1.16(95% CI 1.06 to 1.29)), combined CV death and hospitalised heart failure (HR 1.29(95% CI 1.09 to 1.54)) and all-cause mortality (HR 1.34(95% CI 1.13 to 1.58), all p<0.01).
In patients with initially mild-moderate AS, higher LV mass-wall stress-heart rate product was associated with higher mortality and heart failure hospitalisation. Our results suggest that higher myocardial oxygen demand is contributing to the higher adverse event rate reported in AS patients with LV hypertrophy.
NCT000092677;Post-results.
左心室（LV）肥厚与主动脉瓣狭窄（AS）患者更高的不良事件发生率相关，增加的心肌需氧量是否可以解释这种关联尚不清楚。
本研究使用了 1522 例无症状、多数为中度 AS 的患者的数据，这些患者参加了 Simvastatin-Ezetimibe in AS 研究，中位随访时间为 4.3 年。高 LV 质量-壁应力-心率乘积被定义为正常受试者中上限 95%CI 范围以上。在 Cox 回归分析中检验较高的 LV 质量-壁应力-心率乘积与主要心血管（CV）事件、CV 死亡和心力衰竭住院以及全因死亡率的相关性，并以 HR 和 95%CI 报告。
基线时发现 19%的患者存在高 LV 质量-壁应力-心率乘积，与男性、较高的体重指数、高血压、LV 肥厚、更严重的 AS 和较低的 LV 射血分数相关（均 p<0.01）。在时变 Cox 回归分析中调整这些混杂因素后，1 个标准差更高的 LV 质量-壁应力-心率乘积与主要 CV 事件（HR 1.16（95%CI 1.06 至 1.29））、CV 死亡和心力衰竭住院（HR 1.29（95%CI 1.09 至 1.54））和全因死亡率（HR 1.34（95%CI 1.13 至 1.58））的 HR 较高相关（均 p<0.01）。
在最初轻度至中度 AS 的患者中，较高的 LV 质量-壁应力-心率乘积与更高的死亡率和心力衰竭住院率相关。我们的结果表明，较高的心肌需氧量是导致 AS 患者 LV 肥厚不良事件发生率较高的原因之一。
NCT000092677；Post-results。
