Cardiology Department, Hartcentrum OLV Aalst, Aalst, Belgium.
Department of Advanced Biomedical Sciences, Federico II University Hospital, Napoli, Campania, Italy.
Heart. 2023 Mar 27;109(8):634-642. doi: 10.1136/heartjnl-2022-321874.
Heart valve clinics (HVC) have been introduced to manage patients with valvular heart disease within a multidisciplinary team.
To determine the outcome benefit of HVC approach compared with standard of care (SOC) for patients with moderate and asymptomatic severe aortic stenosis (mAS and asAS).
Single-centre, observational registry of patients with mAS and asAS with at least one cardiac ambulatory consultation at our Cardiovascular Centre. Based on the outpatient strategy, patients were divided into HVC group, if receiving at least one visit at HVC, and SOC group, if followed by routine cardiac consultations.
2129 patients with mAS and asAS were divided into those followed in HVC (n=251) versus SOC group (n=1878). The mean age was 76.5±12.4 years; 919 (43.2%) had asAS. During a follow-up of 4.8±1.8 years, 822 patients (38.6%) died, 307 (14.4%) were hospitalised for heart failure and 596 (28%) underwent aortic valve replacement (AVR). After propensity score matching, the number of consultations per year, exercise stress tests, brain natriuretic peptide (BNP) determinations and CTs were higher in the HVC cohort (p<0.05 for all). A shorter time between indication of AVR and less advanced New York Heart Association class was reported in the HVC cohort (p<0.001 and p=0.032). Compared with SOC, the HVC approach was associated with reduced all-cause mortality (HR=0.63, 95% CI 0.40 to 0.98, p=0.038) and cardiovascular death (p=0.030). At multivariable analysis, the HVC remained an independent predictor of all-cause mortality (HR=0.54, 95% CI 0.34 to 0.85, p=0.007).
In patients with mAS and asAS, the HVC approach was associated with more efficient management and outcome benefit compared with SOC.
心脏瓣膜门诊（HVC）已被引入多学科团队中，以管理患有瓣膜性心脏病的患者。
确定与标准治疗（SOC）相比，HVC 方法对患有中度无症状严重主动脉瓣狭窄（mAS 和 asAS）的患者的治疗结局获益。
对在我们心血管中心至少进行过一次心脏门诊就诊的 mAS 和 asAS 患者进行单中心、观察性注册登记。根据门诊策略，患者被分为 HVC 组（如果至少在 HVC 就诊一次）和 SOC 组（如果接受常规心脏就诊）。
2129 例 mAS 和 asAS 患者被分为 HVC 组（n=251）和 SOC 组（n=1878）。平均年龄为 76.5±12.4 岁；919 例（43.2%）为 asAS。在 4.8±1.8 年的随访期间，822 例患者（38.6%）死亡，307 例（14.4%）因心力衰竭住院，596 例（28%）接受了主动脉瓣置换术（AVR）。在倾向评分匹配后，HVC 组每年就诊次数、运动应激试验、脑钠肽（BNP）测定和 CT 检查均较高（p<0.05 均）。HVC 组报告的 AVR 指示时间更短，纽约心脏协会（NYHA）心功能分级较低（p<0.001 和 p=0.032）。与 SOC 相比，HVC 方法与降低全因死亡率相关（HR=0.63，95%CI 0.40 至 0.98，p=0.038）和心血管死亡率（p=0.030）。多变量分析表明，HVC 仍然是全因死亡率的独立预测因素（HR=0.54，95%CI 0.34 至 0.85，p=0.007）。
在患有 mAS 和 asAS 的患者中，与 SOC 相比，HVC 方法与更有效的管理和治疗结局获益相关。
