Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University.
Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital.
Circ J. 2022 Oct 25;86(11):1769-1776. doi: 10.1253/circj.CJ-21-1062. Epub 2022 Oct 15.
There is scarce data evaluating the current practice pattern and clinical outcomes for patients with severe aortic stenosis (AS), including both those who underwent surgical aortic valve replacement (SAVR) or transcatheter aortic valve implantation (TAVI) and those who were managed conservatively in the TAVI era.
The Contemporary outcomes after sURgery and medical tREatmeNT in patients with severe Aortic Stenosis (CURRENT AS) Registry-2 is a prospective, physician-initiated, multicenter registry enrolling consecutive patients who were diagnosed with severe AS between April 2018 and December 2020 among 21 centers in Japan. The rationale for the prospective enrollment was to standardize the assessment of symptomatic status, echocardiographic evaluation, and other recommended diagnostic examinations such as computed tomography and measurement of B-type natriuretic peptide. Moreover, the schedule of clinical and echocardiographic follow up was prospectively defined and strongly recommended for patients who were managed conservatively. The entire study population consisted of 3,394 patients (mean age: 81.6 years and women: 60%). Etiology of AS was degenerative in 90% of patients. AS-related symptoms were present in 60% of patients; these were most often heart failure symptoms. The prevalence of high- and low-gradient AS was 58% and 42%, respectively, with classical and paradoxical low-flow low-gradient AS in 4.6% and 6.7%, respectively.
The CURRENT AS Registry-2 might be large and meticulous enough to determine the appropriate timing of intervention for patients with severe AS in contemporary clinical practice.
目前关于重度主动脉瓣狭窄（AS）患者的治疗模式和临床结局的数据较少，包括接受外科主动脉瓣置换术（SAVR）或经导管主动脉瓣植入术（TAVI）以及在 TAVI 时代接受保守治疗的患者。
《当代重度主动脉瓣狭窄患者手术和药物治疗结局（CURRENT AS）登记研究-2》是一项前瞻性、医师发起的、多中心登记研究，在日本 21 个中心于 2018 年 4 月至 2020 年 12 月期间连续纳入被诊断为重度 AS 的患者。前瞻性纳入的理由是标准化评估症状状态、超声心动图评估以及其他推荐的诊断检查，如计算机断层扫描和 B 型利钠肽测量。此外，还前瞻性地定义了保守治疗患者的临床和超声心动图随访时间表，并强烈建议进行随访。整个研究人群由 3394 例患者组成（平均年龄：81.6 岁，女性占 60%）。90%的患者 AS 病因是退行性的。60%的患者存在 AS 相关症状，这些症状通常是心力衰竭的症状。高梯度 AS 和低梯度 AS 的患病率分别为 58%和 42%，经典型和矛盾性低流量低梯度 AS 的患病率分别为 4.6%和 6.7%。
CURRENT AS 登记研究-2 可能足够大且细致，能够确定当代临床实践中重度 AS 患者进行干预的适当时机。
