Cardiovascular Research Foundation, New York, New York, USA; Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA; INSERM U1011-EGID, Centre Hospitalier Universitaire de Lille, Institut Pasteur de Lille, Université de Lille, Lille, France.
Cardiovascular Research Foundation, New York, New York, USA; Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA.
JACC Cardiovasc Interv. 2022 Aug 22;15(16):1664-1674. doi: 10.1016/j.jcin.2022.06.022.
The clinical course of patients with moderate aortic stenosis (AS) remains incompletely defined.
This study sought to analyze the clinical course of moderate AS and compare it with other stages of the disease.
Multiple electronic databases were searched to identify studies on adult moderate AS. Random-effects models were used to derive pooled estimates. The primary endpoint was all-cause death. The secondary endpoints were cardiac death, heart failure, sudden death, and aortic valve replacement.
Among a total of 25 studies (12,143 moderate AS patients, 3.7 years of follow-up), pooled rates per 100 person-years were 9.0 (95% CI: 6.9 to 11.7) for all-cause death, 4.9 (95% CI: 3.1 to 7.5) for cardiac death, 3.9 (95% CI: 1.9 to 8.2) for heart failure, 1.1 (95% CI: 0.8 to 1.5) for sudden death, and 7.2 (95% CI: 4.3 to 12.2) for aortic valve replacement. Meta-regression analyses detected that diabetes (P = 0.019), coronary artery disease (P = 0.017), presence of symptoms (P < 0.001), and left ventricle (LV) dysfunction (P = 0.009) were associated with a significant impact on the overall estimate of all-cause death. All-cause mortality was higher in patients with reduced LV ejection fraction (<50%) than with normal LV ejection fraction: 16.5 (95% CI: 5.2 to 52.3) and 4.2 (95% CI: 1.4 to 12.8) per 100 person-years, respectively. Compared with moderate AS, the incidence rate difference of all-cause mortality was -3.9 (95% CI: -6.7 to -1.1) for no or mild AS and +2.2 (95% CI: +0.8 to +3.5) for severe AS patients.
Moderate AS appears to be associated with a mortality risk higher than no or mild AS but lower than severe AS, which increases in specific population subsets. The impact of early intervention in moderate AS patients having high-risk features deserves further investigation.
中度主动脉瓣狭窄（AS）患者的临床病程仍不完全明确。
本研究旨在分析中度 AS 的临床病程，并将其与其他疾病阶段进行比较。
检索多个电子数据库以确定有关成人中度 AS 的研究。使用随机效应模型得出汇总估计值。主要终点为全因死亡。次要终点为心脏性死亡、心力衰竭、猝死和主动脉瓣置换。
在总共 25 项研究（12143 例中度 AS 患者，3.7 年随访）中，每 100 人年的累积发生率分别为全因死亡 9.0（95%CI：6.9 至 11.7）、心脏性死亡 4.9（95%CI：3.1 至 7.5）、心力衰竭 3.9（95%CI：1.9 至 8.2）、猝死 1.1（95%CI：0.8 至 1.5）和主动脉瓣置换 7.2（95%CI：4.3 至 12.2）。荟萃回归分析检测到糖尿病（P = 0.019）、冠状动脉疾病（P = 0.017）、存在症状（P<0.001）和左心室（LV）功能障碍（P = 0.009）与全因死亡的总体估计值有显著影响。射血分数降低（<50%）的患者全因死亡率高于射血分数正常（≥50%）的患者：每 100 人年分别为 16.5（95%CI：5.2 至 52.3）和 4.2（95%CI：1.4 至 12.8）。与中度 AS 相比，无或轻度 AS 的全因死亡率发生率差异为-3.9（95%CI：-6.7 至-1.1），重度 AS 患者为+2.2（95%CI：+0.8 至+3.5）。
中度 AS 似乎与高于无或轻度 AS 的死亡率风险相关，但低于重度 AS，在特定人群亚组中风险增加。进一步研究早期干预中度 AS 高危特征患者的效果是值得的。
