Alcón Blanca, Martínez-Legazpi Pablo, Stewart Simon, Gonzalez-Mansilla Ana, Cuadrado Víctor, Strange Geoff, Yotti Raquel, Cascos Enric, Delgado-Montero Antonia, Prieto-Arévalo Raquel, Mombiela Teresa, Rodríguez-González Elena, Espinosa M Ángeles, Postigo Andrea, Gutiérrez-Ibanes Enrique, Pérez-Vallina Manuel, Fernández-Avilés Francisco, Playford David, Bermejo Javier
Department of Cardiology, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, and CIBERCV, Dr. Esquerdo 46, 28007 Madrid, Spain.
Department of Mathematical Physics and Fluids, Facultad de Ciencias, Universidad Nacional de Educación a Distancia, UNED, and CIBERCV, Madrid, Spain.
Eur Heart J Cardiovasc Imaging. 2022 Apr 18;23(5):601-612. doi: 10.1093/ehjci/jeac003.
The interplay between aortic stenosis (AS), cardiovascular events, and mortality is poorly understood. In addition, how echocardiographic indices compare for predicting outcomes remains unexplored for the full range of AS severity.
We prospectively calculated peak jet velocity (Vmax) and aortic valve area (AVA) in 5994 adult subjects with and without AS. We linked ultrasound data to 5-year mortality and clinical events obtained from electronic medical records. Proportional-hazard and negative binomial regression models were adjusted for relevant covariables such as age, sex, comorbidities, stroke-volume, LV ejection fraction, left valve regurgitation, aortic valve sclerosis or calcification, and valve replacement. We observed a strong linear relationship between Vmax and all-cause mortality (hazard ratio: 1.26, 95% confidence interval: 1.19-1.33 per 100 cm/s), cardiovascular events, as well as incidental and recurrent heart failure (HF). Adjusted risks were highly significant even at Vmax values in the range of 150-200 cm/s, risk curves separating very early after the index exam. Vmax was not associated with coronary, arrhythmic, cerebrovascular, or non-cardiovascular events. Although risks were confirmed when AVA was entered in place of Vmax, the risks estimated for categories based on the two indices were mismatched, even in patients with normal flow. An external cohort comprising 112 690 patients confirmed augmented risks of all-cause and cardiovascular mortality starting at values of Vmax and AVA in the range of mild AS.
Aortic stenosis is strongly associated to all-cause mortality, cardiovascular mortality, and cardiac events, specifically HF. Risks increase in parallel to the degree of outflow obstruction but are apparent very early in patients with mild disease. Criteria for grading AS based on Vmax and AVA are mismatched in terms of outcomes.
主动脉瓣狭窄（AS）、心血管事件和死亡率之间的相互作用尚未完全明确。此外，对于整个AS严重程度范围内，超声心动图指标在预测预后方面的比较情况仍未得到充分探索。
我们前瞻性地计算了5994名有或无AS的成年受试者的峰值射流速度（Vmax）和主动脉瓣面积（AVA）。我们将超声数据与从电子病历中获取的5年死亡率和临床事件相关联。比例风险和负二项回归模型针对年龄、性别、合并症、每搏输出量、左心室射血分数、左瓣膜反流、主动脉瓣硬化或钙化以及瓣膜置换等相关协变量进行了调整。我们观察到Vmax与全因死亡率（风险比：1.26，95%置信区间：每100 cm/s为1.19 - 1.33）、心血管事件以及偶发性和复发性心力衰竭（HF）之间存在强烈的线性关系。即使在Vmax值为150 - 200 cm/s范围内，调整后的风险也非常显著，风险曲线在索引检查后很早就开始分离。Vmax与冠状动脉、心律失常、脑血管或非心血管事件无关。尽管用AVA替代Vmax时风险得到了证实，但基于这两个指标的类别所估计的风险并不匹配，即使在血流正常的患者中也是如此。一个包含112690名患者的外部队列证实，从轻度AS范围内的Vmax和AVA值开始，全因和心血管死亡率的风险就会增加。
主动脉瓣狭窄与全因死亡率、心血管死亡率和心脏事件，特别是HF密切相关。风险随着流出道梗阻程度的增加而平行上升，但在轻度疾病患者中很早就很明显。基于Vmax和AVA对AS进行分级的标准在预后方面并不匹配。
