Quebec Heart and Lung Institute, Laval University, Quebec, Quebec, Canada.
Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands; Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia.
J Am Coll Cardiol. 2022 Sep 13;80(11):1071-1084. doi: 10.1016/j.jacc.2022.06.032.
The prognostic impact of left ventricular ejection fraction (LVEF) in patients with bicuspid aortic valve (BAV) disease has not been previously studied.
The purpose of this study was to determine the prognostic impact of LVEF in BAV patients according to the type of aortic valve dysfunction.
We retrospectively analyzed the data collected in 2,672 patients included in an international registry of patients with BAV. Patients were classified according to the type of aortic valve dysfunction: isolated aortic stenosis (AS) (n = 749), isolated aortic regurgitation (AR) (n = 554), mixed aortic valve disease (MAVD) (n = 190), or no significant aortic valve dysfunction (n = 1,179; excluded from this analysis). The study population was divided according to LVEF strata to investigate its impact on clinical outcomes.
The risk of all-cause mortality and the composite endpoint of aortic valve replacement or repair (AVR) and all-cause mortality increased when LVEF was <60% in the whole cohort as well as in the AS and AR groups, and when LVEF was <55% in MAVD group. In multivariable analysis, LVEF strata were significantly associated with increased rate of mortality (LVEF 50%-59%: HR: 1.83 [95% CI: 1.09-3.07]; P = 0.022; LVEF 30%-49%: HR: 1.97 [95% CI: 1.13-3.41]; P = 0.016; LVEF <30%: HR: 4.20 [95% CI: 2.01-8.75]; P < 0.001; vs LVEF 60%-70%, reference group).
In BAV patients, the risk of adverse clinical outcomes increases significantly when the LVEF is <60%. These findings suggest that LVEF cutoff values proposed in the guidelines to indicate intervention should be raised from 50% to 60% in AS or AR and 55% in MAVD.
左心室射血分数（LVEF）在二叶式主动脉瓣（BAV）疾病患者中的预后影响尚未得到研究。
本研究旨在根据主动脉瓣功能障碍的类型确定 LVEF 在 BAV 患者中的预后影响。
我们回顾性分析了纳入国际 BAV 患者注册研究的 2672 例患者的数据。根据主动脉瓣功能障碍的类型对患者进行分类：孤立性主动脉瓣狭窄（AS）（n=749）、孤立性主动脉瓣反流（AR）（n=554）、混合性主动脉瓣疾病（MAVD）（n=190）或无明显主动脉瓣功能障碍（n=1179；排除在此分析之外）。根据 LVEF 分层，将研究人群分为不同亚组，以研究其对临床结局的影响。
在整个队列以及 AS 和 AR 组中，当 LVEF<60%时，全因死亡率和主动脉瓣置换或修复（AVR）和全因死亡率的复合终点风险增加，而在 MAVD 组中，当 LVEF<55%时，风险增加。多变量分析显示，LVEF 分层与死亡率增加显著相关（LVEF 50%-59%：HR：1.83 [95%CI：1.09-3.07]；P=0.022；LVEF 30%-49%：HR：1.97 [95%CI：1.13-3.41]；P=0.016；LVEF<30%：HR：4.20 [95%CI：2.01-8.75]；P<0.001；与 LVEF 60%-70%，参考组）。
在 BAV 患者中，当 LVEF<60%时，不良临床结局的风险显著增加。这些发现表明，指南中建议干预的 LVEF 截断值应在 AS 或 AR 中从 50%提高到 60%，在 MAVD 中提高到 55%。
