轻中度主动脉瓣狭窄和冠状动脉疾病的长期预后。

Long-term Prognosis of Mild to Moderate Aortic Stenosis and Coronary Artery Disease.

机构信息

Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea.

Division of Cardiology, Hallym Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea.

出版信息

J Korean Med Sci. 2021 Feb 8;36(6):e47. doi: 10.3346/jkms.2021.36.e47.

DOI:10.3346/jkms.2021.36.e47

PMID:33559407

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7870422/

Abstract

BACKGROUND

There is an incomplete understanding of the natural course of mild to moderate aortic stenosis (AS). We aimed to evaluate the natural course of patients with mild to moderate AS and its association with coronary artery disease (CAD).

METHODS

We retrospectively analyzed 787 patients diagnosed with mild to moderate AS using echocardiography between 2004 and 2010. Cardiac death and aortic valve replacement (AVR) for AS were assessed.

RESULTS

A median follow-up period was 92 months. Compared to the general population, patients with mild to moderate AS had a higher risk of cardiac death (hazard ratio [HR], 17.16; 95% confidence interval [CI], 13.65-21.59; < 0.001). Established CAD was detected in 22.4% and associated with a significantly higher risk of cardiac mortality (adjusted HR, 1.62; 95% CI, 1.04-2.53; = 0.033). The risk of cardiac death was lower when patients were taking statin (adjusted HR, 0.64; 95% CI, 0.41-0.98; = 0.041), which was clear only after 7 years. Both patients with CAD and on statin tended to undergo more AVR, but the difference was not statistically significant (the presence of established CAD; adjusted HR, 1.63; 95% CI, 0.51-3.51; = 0.214 and the use of statin; adjusted HR, 1.86; 95% CI, 0.76-4.58; = 0.177).

CONCLUSION

Mild to moderate AS does not have a benign course. The presence of CAD and statin use may affect the long-term prognosis of patients with mild to moderate AS.

摘要

背景

人们对轻度至中度主动脉瓣狭窄（AS）的自然病程了解不完整。我们旨在评估轻度至中度 AS 患者的自然病程及其与冠状动脉疾病（CAD）的关系。

方法

我们回顾性分析了 2004 年至 2010 年间使用超声心动图诊断为轻度至中度 AS 的 787 例患者。评估了心脏性死亡和主动脉瓣置换（AVR）治疗 AS 的情况。

结果

中位随访时间为 92 个月。与普通人群相比，轻度至中度 AS 患者的心脏性死亡风险更高（风险比[HR]，17.16；95%置信区间[CI]，13.65-21.59；<0.001）。检测到 22.4%的患者存在已确立的 CAD，且与心脏死亡率显著升高相关（调整 HR，1.62；95%CI，1.04-2.53；=0.033）。当患者服用他汀类药物时，心脏死亡风险降低（调整 HR，0.64；95%CI，0.41-0.98；=0.041），但仅在 7 年后才变得明显。患有 CAD 和服用他汀类药物的患者更倾向于进行 AVR，但差异无统计学意义（存在已确立的 CAD；调整 HR，1.63；95%CI，0.51-3.51；=0.214 和使用他汀类药物；调整 HR，1.86；95%CI，0.76-4.58；=0.177）。