Yuan Tan, Lu Yi, Bian Chang, Cai Zhejun
Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Jiaxing Key Laboratory of Cardiac Rehabilitation, Jiaxing, China.
Front Cardiovasc Med. 2021 Feb 3;7:621149. doi: 10.3389/fcvm.2020.621149. eCollection 2020.
Aortic stenosis (AS) is the most common valvular disease in developed countries. Until now, the specific timing of intervention for asymptomatic patients with severe aortic stenosis and preserved ejection fraction remains controversial. A systematic search of four databases (Pubmed, Web of science, Cochrane library, Embase) was conducted. Studies of asymptomatic patients with severe AS or very severe AS and preserved left ventricular ejection fraction underwent early aortic valve replacement (AVR) or conservative care were included. The end points included all-cause mortality, cardiac mortality, and non-cardiac mortality. Four eligible studies were identified with a total of 1,249 participants. Compared to conservative management, patients who underwent early AVR were associated with lower all-cause mortality, cardiac mortality, and non-cardiac mortality rate (OR 0.16, 95% CI 0.09-0.31, < 0.00001; OR 0.12, 95% CI 0.02-0.62, = 0.01; OR 0.36, 95% CI 0.21-0.63, = 0.0003, respectively). Early AVR is preferable for asymptomatic severe AS patients with preserved ejection fraction.
主动脉瓣狭窄（AS）是发达国家最常见的瓣膜疾病。迄今为止，对于无症状的重度主动脉瓣狭窄且射血分数保留的患者，具体的干预时机仍存在争议。我们对四个数据库（PubMed、科学网、Cochrane图书馆、Embase）进行了系统检索。纳入了对无症状的重度AS或极重度AS且左心室射血分数保留的患者进行早期主动脉瓣置换术（AVR）或保守治疗的研究。终点包括全因死亡率、心脏死亡率和非心脏死亡率。共确定了四项符合条件的研究，总计1249名参与者。与保守治疗相比，接受早期AVR的患者全因死亡率、心脏死亡率和非心脏死亡率较低（OR分别为0.16，95%CI为0.09 - 0.31，<0.00001；OR为0.12，95%CI为0.02 - 0.62，P = 0.01；OR为0.36，95%CI为0.21 - 0.63，P = 0.0003）。对于无症状的重度AS且射血分数保留的患者，早期AVR是更可取的。
