严重主动脉瓣狭窄在低流量状态伴发心房颤动中的高发率。
High Prevalence of Severe Aortic Stenosis in Low-Flow State Associated With Atrial Fibrillation.
机构信息
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (S.A., S.K., S.V.P., J.J.T., E.A.E.-A., K.M., D.O., S.A.L., R.P., C.E.L., R.B.M., P.A.P., J.K.O., V.T.N.).
Minneapolis Heart Institute, Minneapolis, MN (S.A.).
出版信息
Circ Cardiovasc Imaging. 2021 Jul;14(7):e012453. doi: 10.1161/CIRCIMAGING.120.012453. Epub 2021 Jul 12.
BACKGROUND
Atrial fibrillation (AF) is a low-flow state and may underestimate aortic stenosis (AS) severity. Single-high Doppler signals (HS) consistent with severe AS (peak velocity ≥4 m/s or mean gradient ≥40 mm Hg) are averaged down in current practice. The objective for the study was to determine the significance of HS in AF low-gradient AS (LGAS).
METHODS
One thousand five hundred forty-one patients with aortic valve area ≤1 cm and left ventricular ejection fraction ≥50% were identified and classified as high-gradient AS (HGAS) (≥40 mm Hg) and LGAS (<40 mm Hg), and AF versus sinus rhythm (SR). Available computed tomography aortic valve calcium scores (AVCS) were retrieved from the medical record. Outcomes were assessed.
RESULTS
Mean age was 76±11 years, female 47%. Mean gradient was 51±12 in SR-HGAS, 48±10 in AF-HGAS, 31±5 in SR-LGAS, and 29±7 mm Hg in AF-LGAS, all ≤0.001 versus SR-HGAS; HS were present in 33% of AF-LGAS. AVCS were available in 34%. Compared with SR-HGAS (2409 arbitrary units; interquartile range, 1581-3462) AVCS were higher in AF-HGAS (2991 arbitrary units; IQR1978-4229, =0.001), not different in AF-LGAS (2399 arbitrary units; IQR1817-2810, =0.47), and lower in SR-LGAS (1593 arbitrary units; IQR945-1832, <0.001); AVCS in AF-LGAS were higher when HS were present (=0.048). Compared with SR-HGAS, the age-, sex-, comorbidity index-, and time-dependent aortic valve replacement-adjusted mortality risk was higher in AF-HGAS (hazard ratio=1.82 [1.40-2.36], <0.001) and AF-LGAS with HS (hazard ratio=1.54 [1.04-2.26], =0.03) but not different in AF-LGAS without HS or SR-LGAS (both =not significant).
CONCLUSIONS
Severe AS was common in AF-LGAS. AVCS in AF-LGAS were not different from SR-HGAS. AVCS were higher and mortality worse in AF-LGAS when HS were present.
背景
心房颤动（AF）是一种低流量状态，可能会低估主动脉瓣狭窄（AS）的严重程度。目前的实践中，平均化了符合严重 AS（峰值速度≥4m/s 或平均梯度≥40mmHg）的单高多普勒信号（HS）。本研究的目的是确定 AF 低梯度 AS（LGAS）中 HS 的意义。
方法
共确定了 1541 例主动脉瓣面积≤1cm 和左心室射血分数≥50%的患者，并分为高梯度 AS（HGAS）（≥40mmHg）和 LGAS（<40mmHg），以及 AF 与窦性节律（SR）。从病历中检索到可用的计算机断层扫描主动脉瓣钙评分（AVCS）。评估了结局。
结果
平均年龄为 76±11 岁，女性占 47%。SR-HGAS 的平均梯度为 51±12mmHg，AF-HGAS 为 48±10mmHg，SR-LGAS 为 31±5mmHg，AF-LGAS 为 29±7mmHg，均≤0.001 与 SR-HGAS 相比；33%的 AF-LGAS 中存在 HS。34%的患者可获得 AVCS。与 SR-HGAS（2409 个任意单位；四分位距 1581-3462）相比，AF-HGAS 的 AVCS 更高（2991 个任意单位；四分位距 1978-4229，=0.001），AF-LGAS 中的 AVCS 无差异（2399 个任意单位；四分位距 1817-2810，=0.47），而 SR-LGAS 中的 AVCS 较低（1593 个任意单位；四分位距 945-1832，<0.001）；存在 HS 时，AF-LGAS 中的 AVCS 更高（=0.048）。与 SR-HGAS 相比，AF-HGAS（危险比=1.82[1.40-2.36]，<0.001）和存在 HS 的 AF-LGAS（危险比=1.54[1.04-2.26]，=0.03）的年龄、性别、合并症指数和时间依赖性主动脉瓣置换调整死亡率风险较高，但 AF-LGAS 中无 HS 或 SR-LGAS 无差异（均=无显著差异）。
结论
AF-LGAS 中常见严重 AS。AF-LGAS 中的 AVCS 与 SR-HGAS 无差异。当存在 HS 时，AF-LGAS 中的 AVCS 更高，死亡率更差。
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