Bravo-Jaimes Katia, Palaskas Nicolas L, Banchs Jose, Abelhad Nadia I, Altaf Alveena, Gouni Sushanth, Song Juhee, Hassan Saamir A, Iliescu Cezar, Deswal Anita, Yusuf Syed Wamique
Division of Cardiology, Department of Medicine, University of Texas Health Science Center at Houston, Houston, TX, United States.
Division of Internal Medicine, Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, TX, United States.
Front Cardiovasc Med. 2021 Mar 18;8:644264. doi: 10.3389/fcvm.2021.644264. eCollection 2021.
Patients with cancer and aortic stenosis (AS) are exposed to several factors that could accelerate the progression of AS. This study aimed to determine the cumulative incidence of AS progression and associated factors in these patients. This retrospective cohort study included patients with cancer, mild or moderate AS and at least two echocardiograms 6 months apart between 1996 and 2016 at MD Anderson Cancer Center. AS progression was defined by an increase in mean gradient of 20 mmHg or peak velocity of 2 m/s by spectral Doppler echocardiography or as requiring aortic valve replacement. Univariate and multivariable Fine-Gray models to account for the competing risk of death were used. One hundred and two patients were included and median follow-up was 7.3 years. Overall, 30 patients (29%) developed AS progression, while 48 (47%) died without it. Yearly rate of mean gradient change was 4.9 ± 3.9 mmHg and yearly rate of peak velocity change was 0.23 ± 0.29 m/s for patients who developed AS progression. In the univariate analysis, coronary artery disease (CAD), dyspnea, prevalent cyclophosphamide and beta-blocker use were associated with AS progression. In multivariable analysis, CAD and prevalent cyclophosphamide use for the time interval of more than 3 years of follow-up remained significantly associated with increased cumulative incidence of AS progression. In conclusion, patients with mild or moderate AS and cancer are more likely to die before having AS progression. AS progression is associated with CAD and prevalent cyclophosphamide use.
患有癌症和主动脉瓣狭窄（AS）的患者会受到多种可能加速AS进展的因素影响。本研究旨在确定这些患者中AS进展的累积发生率及相关因素。这项回顾性队列研究纳入了1996年至2016年期间在MD安德森癌症中心患有癌症、轻度或中度AS且至少有两次间隔6个月的超声心动图检查的患者。AS进展的定义为通过频谱多普勒超声心动图测量平均压差增加20 mmHg或峰值流速增加2 m/s，或需要进行主动脉瓣置换。使用单变量和多变量Fine-Gray模型来考虑死亡的竞争风险。共纳入102例患者，中位随访时间为7.3年。总体而言，30例患者（29%）出现AS进展，而48例（47%）未进展而死亡。出现AS进展的患者平均压差的年变化率为4.9±3.9 mmHg，峰值流速的年变化率为0.23±0.29 m/s。在单变量分析中，冠状动脉疾病（CAD）、呼吸困难、既往使用环磷酰胺和β受体阻滞剂与AS进展相关。在多变量分析中，随访时间超过3年的CAD和既往使用环磷酰胺仍与AS进展累积发生率增加显著相关。总之，患有轻度或中度AS和癌症的患者在AS进展之前更有可能死亡。AS进展与CAD和既往使用环磷酰胺有关。
