Division of Cardiology, University of North Carolina School of Medicine, Chapel Hill (K.S., S.A., M.H., T.S., P.P.C., T.W., M.A.C., J.P.V.).
Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.V.).
Circ Heart Fail. 2023 Mar;16(3):e009653. doi: 10.1161/CIRCHEARTFAILURE.122.009653. Epub 2023 Feb 3.
Few studies characterize the epidemiology and outcomes of aortic stenosis (AS) in acute decompensated heart failure (ADHF). This study investigates the significance of AS in contemporary patients who have experienced an ADHF hospitalization.
The ARIC study (Atherosclerosis Risk in Communities) surveilled ADHF hospitalizations for residents ≥55 years of age in 4 US communities. ADHF cases were stratified by left ventricular ejection fraction (LVEF). Demographic differences in AS burden and the association of varying AS severities with mortality were estimated using multivariable logistic regression.
From 2005 through 2014, there were 3597 (weighted n=16 692) ADHF hospitalizations of which 48.6% had an LVEF <50% and 51.4% an LVEF ≥50%. AS prevalence was 12.1% and 18.7% in those with an LVEF <50% and ≥50%, respectively. AS was less likely in Black than White patients regardless of LVEF: LVEF <50% (odds ratio [OR], 0.34 [95% CI, 0.28-0.42]); LVEF ≥50% (OR, 0.51 [95% CI, 0.44-0.59]). Higher AS severity was independently associated with 1-year mortality in both LVEF subgroups: LVEF <50% (OR, 1.16 [95% CI, 1.04-1.28]); LVEF ≥50% (OR, 1.40 [95% CI, 1.28-1.54]). Sensitivity analyses excluding severe AS patients detected that mild/moderate AS was independently associated with 1-year mortality in both LVEF subgroups: LVEF <50% (OR, 1.23 [95% CI, 1.02-1.47]); LVEF ≥50% (OR, 1.31 [95% CI, 1.14-1.51]).
Among patients who have experienced an ADHF hospitalization, AS is prevalent and portends poor mortality outcomes. Notably, mild/moderate AS is independently associated with 1-year mortality in this high-risk population.
很少有研究描述急性失代偿性心力衰竭（ADHF）患者的主动脉瓣狭窄（AS）的流行病学和结局。本研究调查了经历 ADHF 住院治疗的当代患者中 AS 的重要性。
ARIC 研究（社区动脉粥样硬化风险研究）监测了美国 4 个社区中≥55 岁的 ADHF 住院患者。根据左心室射血分数（LVEF）对 ADHF 病例进行分层。使用多变量逻辑回归估计 AS 负担的人群差异以及不同 AS 严重程度与死亡率的关系。
2005 年至 2014 年，共有 3597 例（加权 n=16692）ADHF 住院患者，其中 48.6%的 LVEF<50%，51.4%的 LVEF≥50%。AS 的患病率分别为 LVEF<50%和≥50%患者中的 12.1%和 18.7%。无论 LVEF 如何，AS 在黑人患者中均少于白人患者：LVEF<50%（优势比[OR]，0.34[95%可信区间，0.28-0.42]）；LVEF≥50%（OR，0.51[95%可信区间，0.44-0.59]）。在两个 LVEF 亚组中，较高的 AS 严重程度与 1 年死亡率独立相关：LVEF<50%（OR，1.16[95%可信区间，1.04-1.28]）；LVEF≥50%（OR，1.40[95%可信区间，1.28-1.54]）。排除严重 AS 患者的敏感性分析表明，在两个 LVEF 亚组中，轻度/中度 AS 与 1 年死亡率独立相关：LVEF<50%（OR，1.23[95%可信区间，1.02-1.47]）；LVEF≥50%（OR，1.31[95%可信区间，1.14-1.51]）。
在经历 ADHF 住院治疗的患者中，AS 很常见，预示着死亡率结局不佳。值得注意的是，轻度/中度 AS 与该高危人群的 1 年死亡率独立相关。
