Faculty of Medicine, University of Oslo, Oslo, Norway.
Department of Cardiology, Oslo University Hospital, Rikshospitalet, Norway.
PLoS One. 2021 Apr 7;16(4):e0249610. doi: 10.1371/journal.pone.0249610. eCollection 2021.
Patients with asymptomatic, severe aortic stenosis are presumed to have a benign prognosis. In this retrospective cohort study, we examined the natural history of contemporary patients advised against aortic valve replacement due to a perceived lack of symptoms.
We reviewed the medical records of every patient given the ICD-10-code for aortic stenosis (I35.0) at Oslo University Hospital, Rikshospitalet, between Dec 1st, 2002 and Dec 31st, 2016. Patients who were evaluated by the heart team due to severe aortic stenosis were categorized by treatment strategy. We recorded baseline data, adverse events and survival for the patients characterized as asymptomatic and for 100 age and gender matched patients scheduled for aortic valve replacement.
Of 2341 patients who were evaluated for aortic valve replacement due to severe aortic stenosis, 114 patients received conservative treatment due to a lack of symptoms. Asymptomatic patients had higher mortality than patients who had aortic valve replacement, log-rank p<0.001 (mean follow-up time: 4.0 (SD: 2.5) years). Survival at 1, 2 and 3 years for the asymptomatic patients was 88%, 75% and 63%, compared with 92%, 83% and 78% in the matched patients scheduled for aortic valve replacement. 28 (25%) of the asymptomatic patients had aortic valve replacement during follow-up. Age, previous history of coronary artery disease and N-terminal pro B-type natriuretic peptide (NT-proBNP) were predictors of mortality and coronary artery disease and NT-proBNP were predictors of 3-year morbidity in asymptomatic patients.
In this retrospective study, asymptomatic patients with severe aortic stenosis who were advised against surgery had significantly higher mortality than patients who had aortic valve replacement.
无症状、严重主动脉瓣狭窄的患者被认为预后良好。在这项回顾性队列研究中，我们研究了由于缺乏症状而被建议不进行主动脉瓣置换术的当代患者的自然病程。
我们回顾了 2002 年 12 月 1 日至 2016 年 12 月 31 日期间，在奥斯陆大学医院里克斯医院接受国际疾病分类第 10 版编码为主动脉瓣狭窄（I35.0）的每位患者的医疗记录。由于严重主动脉瓣狭窄而由心脏团队评估的患者，根据治疗策略进行分类。我们记录了无症状患者和 100 名年龄和性别匹配的计划进行主动脉瓣置换术患者的基线数据、不良事件和生存情况。
在因严重主动脉瓣狭窄而接受主动脉瓣置换术评估的 2341 名患者中，114 名因缺乏症状而接受保守治疗。无症状患者的死亡率高于接受主动脉瓣置换术的患者，对数秩检验 p<0.001（平均随访时间：4.0（SD：2.5）年）。无症状患者的 1、2 和 3 年生存率分别为 88%、75%和 63%，而计划进行主动脉瓣置换术的匹配患者分别为 92%、83%和 78%。在随访期间，28 名（25%）无症状患者进行了主动脉瓣置换术。年龄、既往冠心病病史和 N 端脑利钠肽前体（NT-proBNP）是死亡率的预测因素，而冠心病和 NT-proBNP 是无症状患者 3 年发病率的预测因素。
在这项回顾性研究中，被建议不进行手术的无症状严重主动脉瓣狭窄患者的死亡率明显高于接受主动脉瓣置换术的患者。
