Cardiology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal.
Cardiovascular Research & Development Center - UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal.
Int J Cardiovasc Imaging. 2022 Dec;38(12):2645-2653. doi: 10.1007/s10554-022-02673-1. Epub 2022 Jul 3.
The impact of "downstream" pathophysiological cardiac consequences in aortic regurgitation patients were not well established. The aim of our study was to validate a staging system built for severe aortic stenosis in a large real-world cohort of aortic regurgitation (AR) patients, evaluating the prevalence of different stages of cardiac damage and assess its prognostic impact. Clinical, echocardiographic and outcome data of patients with moderate-severe AR who underwent transthoracic echocardiography between January/2014 and September/2019 were retrospectively analysed. Patients were classified according to the extent of cardiac damage: Stage 0 (no cardiac damage), Stage 1 (left ventricular damage), Stage 2 (mitral valve or left atrial damage), Stage 3 (tricuspid valve or pulmonary artery vasculature damage) and Stage 4 (right ventricular damage). The primary endpoint was all-cause mortality. A total of 571 patients (median age 73, 51% male) were enrolled: Stage 0 (14.0%), Stage 1 (21.5%), Stage 2 (49.2%), Stage 3 (12.3%) and Stage 4 (3.0%). Median follow-up time was 39.5 months (IQR 22.2 to 61.0). At the end of follow-up, cumulative death was significantly higher in more advanced disease stages (log-rank p < 0.001). On multivariable analysis, Stage 3-4 was associated with increased risk of all-cause mortality (HR 3.20; 95% CI 1.48-6.93; p = 0.003). Our study suggests that extra-valvular damage is common in patients with significant AR and that a staging system developed for aortic stenosis also provides prognostic information in these patients. This staging system may be helpful for clinical decision-making regarding the time of valvular intervention.
主动脉瓣反流患者的“下游”病理生理心脏后果尚不清楚。我们的研究目的是在一个大型的真实世界的主动脉瓣反流（AR）患者队列中验证一个为严重主动脉瓣狭窄建立的分期系统，评估不同阶段心脏损伤的发生率，并评估其预后影响。回顾性分析了 2014 年 1 月至 2019 年 9 月期间接受经胸超声心动图检查的中重度 AR 患者的临床、超声心动图和结局数据。根据心脏损伤程度对患者进行分类：0 期（无心脏损伤）、1 期（左心室损伤）、2 期（二尖瓣或左心房损伤）、3 期（三尖瓣或肺动脉脉管系统损伤）和 4 期（右心室损伤）。主要终点是全因死亡率。共纳入 571 例患者（中位年龄 73 岁，51%为男性）：0 期（14.0%）、1 期（21.5%）、2 期（49.2%）、3 期（12.3%）和 4 期（3.0%）。中位随访时间为 39.5 个月（IQR 22.2 至 61.0）。随访结束时，疾病分期较高的患者累积死亡率显著较高（对数秩检验 p<0.001）。多变量分析显示，3-4 期与全因死亡率增加相关（HR 3.20；95%CI 1.48-6.93；p=0.003）。我们的研究表明，在有明显 AR 的患者中，瓣周组织损伤很常见，而针对主动脉瓣狭窄建立的分期系统也能为这些患者提供预后信息。该分期系统可能有助于临床决策，即何时进行瓣膜干预。
