Turina J, Hess O, Sepulcri F, Krayenbuehl H P
Eur Heart J. 1987 May;8(5):471-83. doi: 10.1093/oxfordjournals.eurheartj.a062307.
The fate of patients with aortic valve disease of varying degrees of severity and the relationship between symptoms and haemodynamic status have been studied in 190 adults undergoing cardiac catheterization during the last two decades. During the follow-up period, 41 patients died and 86 underwent aortic valve replacement; these two events were the endpoints for the calculation of 'event-free' cumulative survival. First-year survival in haemodynamically severe disease was 60% in aortic stenosis and 96% in aortic regurgitation; in moderate and mild disease (in the absence of coronary artery disease) first-year survival was 100% in both groups. After 10 years, 9% of those with haemodynamically severe aortic stenosis and 17% of those with severe regurgitation were event-free, in contrast to 35% and 22%, respectively, of those with moderate changes and 85% and 75%, respectively, of those with mild abnormalities. In the presence of haemodynamically severe disease, 66% of the patients with stenosis and 14% of those with regurgitation were severely symptomatic (history of heart failure, syncope or New York Heart Association class III and IV); 23% of patients with moderate stenosis and 14% with moderate regurgitation were also severely symptomatic. Only 40% of those with disease that was severe both haemodynamically and symptomatically with either stenosis or regurgitation survived the first two years; only 12% in the stenosis group and none in the regurgitation group were event-free at 5 years. Patients with haemodynamically severe aortic stenosis who had few or no symptoms had a 100% survival at 2 years; the comparable figure for the aortic regurgitation group was 94%; 75% of the patients in the stenosis group and 65% in the regurgitation group were event-free at 5 years. In the moderate or mild stenosis and regurgitation groups there was no mortality within the first 2 years in the absence of coronary artery disease, regardless of symptomatic status. Haemodynamically and symptomatically severe aortic stenosis and regurgitation have a very poor prognosis and require immediate valve surgery. Asymptomatic and mildly symptomatic patients with haemodynamically severe aortic stenosis are at low risk and surgical treatment can be postponed until marked symptoms appear without a significant risk of sudden death. In severe aortic regurgitation, the decision for surgery should depend not only on symptoms but should be considered in patients with few or no symptoms because of risk of sudden death. In the absence of coronary artery disease, moderate aortic valve disease does not require valve operation for prognostic reasons.
在过去二十年中，对190例接受心导管检查的成年患者进行了研究，以了解不同严重程度主动脉瓣疾病患者的预后以及症状与血流动力学状态之间的关系。在随访期间，41例患者死亡，86例接受了主动脉瓣置换术；这两个事件作为计算“无事件”累积生存率的终点。血流动力学严重病变患者中，主动脉瓣狭窄患者的第一年生存率为60%，主动脉瓣关闭不全患者为96%；在中度和轻度病变（无冠状动脉疾病）患者中，两组的第一年生存率均为100%。10年后，血流动力学严重的主动脉瓣狭窄患者中9%无事件发生，严重关闭不全患者中17%无事件发生，相比之下，中度病变患者分别为35%和22%，轻度异常患者分别为85%和75%。在血流动力学严重病变患者中，66%的狭窄患者和14%的关闭不全患者有严重症状（心力衰竭、晕厥病史或纽约心脏协会III级和IV级）；23%的中度狭窄患者和14%的中度关闭不全患者也有严重症状。血流动力学和症状均严重的狭窄或关闭不全患者中，仅40%在头两年存活；狭窄组中仅12%在5年时无事件发生，关闭不全组则无。血流动力学严重但症状轻微或无症状的主动脉瓣狭窄患者2年生存率为100%；主动脉瓣关闭不全组的相应数字为94%；狭窄组中75%的患者和关闭不全组中65%的患者在5年时无事件发生。在中度或轻度狭窄和关闭不全组中，无冠状动脉疾病时，无论症状情况如何，头两年内均无死亡。血流动力学和症状均严重的主动脉瓣狭窄和关闭不全预后很差，需要立即进行瓣膜手术。无症状和症状轻微的血流动力学严重的主动脉瓣狭窄患者风险较低，手术治疗可推迟至出现明显症状且无猝死重大风险时进行。在严重主动脉瓣关闭不全中，手术决策不仅应取决于症状，对于症状轻微或无症状的患者也应考虑，因为存在猝死风险。在无冠状动脉疾病时，中度主动脉瓣疾病因预后原因无需进行瓣膜手术。
