Faculty of Medicine and Health University of Sydney Australia.
Department of Cardiology Royal Prince Alfred Hospital Camperdown Australia.
J Am Heart Assoc. 2021 Nov 16;10(22):e021126. doi: 10.1161/JAHA.121.021126. Epub 2021 Oct 30.
Background The prevalence and outcomes of the different subtypes of severe low-gradient aortic stenosis (AS) in routine clinical cardiology practice have not been well characterized. Methods and Results Data were derived from the National Echocardiography Database of Australia. Of 192 060 adults (aged 62.8±17.8 [mean±SD] years) with native aortic valve profiling between 2000 and 2019, 12 013 (6.3%) had severe AS. Of these, 5601 patients (47%) had high-gradient and 6412 patients (53%) had low-gradient severe AS. The stroke volume index was documented in 2741 (42.7%) patients with low gradient; 1750 patients (64%) with low flow, low gradient (LFLG); and 991 patients with normal flow, low gradient. Of the patients with LFLG, 1570 (89.7%) had left ventricular ejection fraction recorded; 959 (61%) had paradoxical LFLG (preserved left ventricular ejection fraction), and 611 (39%) had classical LFLG (reduced left ventricular ejection fraction). All-cause and cardiovascular-related mortality were assessed in the 8162 patients with classifiable severe AS subtype during a mean±SD follow-up of 88±45 months. Actual 1-year and 5-year all-cause mortality rates varied across these groups and were 15.8% and 49.2% among patients with high-gradient severe AS, 11.6% and 53.6% in patients with normal-flow, low-gradient severe AS, 16.9% and 58.8% in patients with paradoxical LFLG severe AS, and 30.5% and 72.9% in patients with classical LFLG severe AS. Compared with patients with high-gradient severe AS, the 5-year age-adjusted and sex-adjusted mortality risk hazard ratios were 0.94 (95% CI, 0.85-1.03) in patients with normal-flow, low-gradient severe AS; 1.01 (95% CI, 0.92-1.12) in patients with paradoxical LFLG severe AS; and 1.65 (95% CI, 1.48-1.84) in patients with classical LFLG severe AS. Conclusions Approximately half of those patients with echocardiographic features of severe AS in routine clinical practice have low-gradient hemodynamics, which is associated with long-term mortality comparable with or worse than high-gradient severe AS. The poorest survival was associated with classical LFLG severe AS.
在常规临床心脏病学实践中，不同类型的严重低梯度主动脉瓣狭窄（AS）的患病率和结局尚未得到很好的描述。
数据来自澳大利亚国家超声心动图数据库。在 2000 年至 2019 年间进行的 192060 例成人（年龄 62.8±17.8[均值±标准差]岁）的原生主动脉瓣分析中，有 12013 例（6.3%）患有严重 AS。其中，5601 例（47%）为高梯度，6412 例（53%）为低梯度严重 AS。2741 例（42.7%）低梯度患者记录了每搏量指数；1750 例（64%）为低流量、低梯度（LFLG）；991 例为正常流量、低梯度。在 LFLG 患者中，1570 例（89.7%）记录了左心室射血分数；959 例（61%）存在矛盾性 LFLG（左心室射血分数正常），611 例（39%）存在经典性 LFLG（左心室射血分数降低）。在可分类的严重 AS 亚型的 8162 例患者中，平均随访 88±45 个月时评估了全因和心血管相关死亡率。这些组别的实际 1 年和 5 年全因死亡率不同，高梯度严重 AS 患者为 15.8%和 49.2%，正常流量、低梯度严重 AS 患者为 11.6%和 53.6%，矛盾性 LFLG 严重 AS 患者为 16.9%和 58.8%，经典性 LFLG 严重 AS 患者为 30.5%和 72.9%。与高梯度严重 AS 患者相比，5 年年龄和性别调整的死亡率风险比分别为：正常流量、低梯度严重 AS 患者为 0.94（95%CI，0.85-1.03）；矛盾性 LFLG 严重 AS 患者为 1.01（95%CI，0.92-1.12）；经典性 LFLG 严重 AS 患者为 1.65（95%CI，1.48-1.84）。
在常规临床实践中，大约一半有超声心动图特征的严重 AS 患者存在低梯度血流动力学，其长期死亡率与高梯度严重 AS 相当或更差。与经典性 LFLG 严重 AS 患者相比，其预后最差。
