University of Lyon, CREATIS UMR5220, INSERM U1044, INSA-15, 7 avenue Jean Capelle 69621 Villeurbanne Cedex, Lyon, France.
Cardiology Department, Hôpital Croix-Rousse and Hôpital Lyon Sud, Hospices Civils de Lyon, Lyon, France.
Eur Heart J Cardiovasc Imaging. 2022 Mar 22;23(4):508-514. doi: 10.1093/ehjci/jeab039.
In low-gradient aortic stenosis (LGAS), the high valvulo-arterial impedance observed despite low valvular gradient suggests a high vascular load. Thoracic aortic calcifications (TACs) and valvular aortic calcifications (VACs) are, respectively, surrogates of aortic load and aortic valvular gradient. The aim of this study was to compare the respective contributions of TAC and VAC on 3-year cardiovascular (CV) mortality following TAVI in LGAS vs. high-gradient aortic stenosis (HGAS) patients.
A total of 1396 consecutive patients were included. TAC and VAC were measured on the pre-TAVI CT-scan. About 435 (31.2%) patients had LGAS and 961 (68.8%) HGAS. LGAS patients were more prone to have diabetes, coronary artery disease (CAD), atrial fibrillation (AF), and lower left ventricular ejection fraction (LVEF), P<0.05 for all. During the 3 years after TAVI, 245(17.8%) patients experienced CV mortality, 92(21.6%) in LGAS and 153(16.2%) in HGAS patients, P=0.018. Multivariate analysis adjusted for age, gender, diabetes, AF, CAD, LVEF, renal function, vascular access, and aortic regurgitation showed that TAC but not VAC was associated with CV mortality in LGAS, hazard ratio (HR) 1.085 confidence interval (CI) (1.019-1.156), P=0.011, and HR 0.713 CI (0.439-1.8), P=0.235; the opposite was observed in HGAS patients with VAC but not TAC being associated with CV mortality, HR 1.342 CI (1.034-1.742), P=0.027, and HR 1.015 CI (0.955-1.079), P=0.626.
TAC plays a major prognostic role in LGAS while VAC remains the key in HGAS patients. This confirms that LGAS is a complex vascular and valvular disease.
在低梯度主动脉瓣狭窄（LGAS）中，尽管瓣-动脉梯度较低，但观察到的高瓣膜-动脉阻抗提示存在较高的血管负荷。胸主动脉钙化（TAC）和瓣环主动脉钙化（VAC）分别是主动脉负荷和主动脉瓣瓣环梯度的替代指标。本研究旨在比较 LGAS 与高梯度主动脉瓣狭窄（HGAS）患者行经导管主动脉瓣置换术（TAVI）后 3 年心血管（CV）死亡率的各自影响因素。
共纳入 1396 例连续患者。TAC 和 VAC 是在 TAVI 前 CT 扫描上测量的。约 435 例（31.2%）患者为 LGAS，961 例（68.8%）为 HGAS。LGAS 患者更易合并糖尿病、冠状动脉疾病（CAD）、心房颤动（AF）和较低的左心室射血分数（LVEF），所有这些差异均具有统计学意义（P<0.05）。在 TAVI 后 3 年内，245 例（17.8%）患者发生 CV 死亡，LGAS 组 92 例（21.6%），HGAS 组 153 例（16.2%），P=0.018。多变量分析调整了年龄、性别、糖尿病、AF、CAD、LVEF、肾功能、血管通路和主动脉瓣反流等因素，结果表明，在 LGAS 患者中，TAC 而非 VAC 与 CV 死亡率相关，风险比（HR）为 1.085，置信区间（CI）为 1.019-1.156，P=0.011，而 HR 为 0.713，CI（0.439-1.8），P=0.235；而在 HGAS 患者中，VAC 与 CV 死亡率相关，而 TAC 则不相关，HR 为 1.342，CI（1.034-1.742），P=0.027，而 HR 为 1.015，CI（0.955-1.079），P=0.626。
在 LGAS 中，TAC 对预后有重要作用，而 VAC 则是 HGAS 患者的关键。这证实了 LGAS 是一种复杂的血管和瓣膜疾病。
