Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Antwerp Cardiovascular Center, ZNA Middelheim, Antwerp, Belgium.
Am J Cardiol. 2020 Apr 1;125(7):1108-1114. doi: 10.1016/j.amjcard.2019.12.040. Epub 2020 Jan 9.
Aortic stenosis (AS) and renal dysfunction share risk factors and often occur simultaneously. The influence of renal dysfunction on the prognosis of patients with various grades of AS has not been extensively described. The present study aimed to assess the prognostic implications of renal dysfunction in a large cohort of patients with aortic sclerosis and patients with various grades of AS. Patients diagnosed with various grades of AS by transthoracic echocardiography were assessed and divided according to renal function by estimated glomerular filtration rate (eGFR). The occurrence of all-cause mortality (primary end point) and aortic valve replacement (AVR) was noted. Of 1,178 patients (mean age 70 ± 13 years, 60% male), 327 (28%) had aortic sclerosis, 86 (7%) had mild AS, 285 (24%) had moderate AS, and 480 (41%) had severe AS. Renal dysfunction (eGFR <60 ml/min/1.73 m) was present in 440 (37%) patients, and moderate to severe AS was observed more often in these patients compared to patients without (70 vs 62%, respectively; p = 0.008). After a median follow-up of 95 [31 to 149] months, 626 (53%) patients underwent AVR and 549 (47%) patients died. Severely impaired renal function (eGFR <30 ml/min/1.73 m) and AVR were independently associated with all-cause mortality after correcting for AS severity. In conclusion, renal dysfunction is highly prevalent in patients with various grades of AS. After correcting for AS severity and AVR, severely impaired renal function (eGFR <30 ml/min/1.73 m) was independently associated with all-cause mortality. Independent of renal function, AVR was associated with improved survival.
主动脉瓣狭窄（AS）和肾功能障碍具有共同的危险因素，并且常同时发生。肾功能障碍对不同严重程度 AS 患者预后的影响尚未得到广泛描述。本研究旨在评估肾功能障碍对主动脉瓣硬化和不同严重程度 AS 患者的大样本队列的预后意义。通过经胸超声心动图评估诊断为不同严重程度 AS 的患者，并根据估计肾小球滤过率（eGFR）对肾功能进行分组。记录全因死亡率（主要终点）和主动脉瓣置换术（AVR）的发生情况。在 1178 名患者（平均年龄 70 ± 13 岁，60%为男性）中，327 名（28%）患有主动脉瓣硬化，86 名（7%）患有轻度 AS，285 名（24%）患有中度 AS，480 名（41%）患有重度 AS。440 名（37%）患者存在肾功能障碍（eGFR <60 ml/min/1.73 m），与无肾功能障碍患者相比，这些患者中更常观察到中度至重度 AS（分别为 70%和 62%；p = 0.008）。中位随访 95 [31 至 149] 个月后，626 名（53%）患者接受了 AVR，549 名（47%）患者死亡。校正 AS 严重程度后，严重肾功能障碍（eGFR <30 ml/min/1.73 m）和 AVR 与全因死亡率独立相关。结论，不同严重程度 AS 患者中肾功能障碍发生率较高。校正 AS 严重程度和 AVR 后，严重肾功能障碍（eGFR <30 ml/min/1.73 m）与全因死亡率独立相关。无论肾功能如何，AVR 均与生存率提高相关。
