三叶主动脉瓣严重狭窄且瓣膜钙评分低的患者行主动脉瓣置换术后的临床结局

Clinical outcomes after aortic valve replacement with severe stenosis of trileaflet aortic valve and low valve calcium score.

作者信息

Choi Yeonwoo, Ahn Jung-Min, Yang Dong Hyun, Koo Hyun Jung, Lee Seung-Ah, Kang Do-Yoon, Kim Joon Bum, Park Duk-Woo, Kim Dae-Hee, Choo Suk Jung, Park Seung-Jung

机构信息

Division of Cardiology, Asan Medical Center, Seoul, South Korea.

Division of Cardiology, Asan Medical Center, Seoul, South Korea

出版信息

Heart. 2023 Sep 13;109(19):1479-1485. doi: 10.1136/heartjnl-2023-322435.

DOI:10.1136/heartjnl-2023-322435

PMID:37290900

Abstract

BACKGROUND

Some patients have severe aortic valve stenosis (AS) despite a lower degree of aortic valve calcification (AVC). This study compared the clinical features and prognosis of patients undergoing aortic valve replacement (AVR) for severe AS with a low AVC score compared with those with higher AVC scores.

METHODS

This study included 1002 Korean patients with symptomatic severe degenerative AS who underwent AVR. We measured AVC score before AVR and defined low AVC as AVC score of <2000 units for male patients and <1300 units for female patients. Patients with bicuspid or rheumatic aortic valve disease were excluded.

RESULTS

The mean age was 75.6±7.9 years and 487 patients (48.6%) were female. Mean left ventricular ejection fraction was 59.4%±10.4%, and concomitant coronary revascularisation was performed in 96 patients (9.6%). The median aortic valve calcium score was 3122 units (IQR 2249-4289 units) among male patients and 1756 units (IQR 1192-2572) among female patients. A total of 242 patients (24.2%) had low AVC; they were significantly younger (73.5±8.7 years vs 76.3±7.5 years, p<0.001) and were more likely to be female (59.5% vs 45.1%, p<0.001) and on haemodialysis (5.4% vs 1.8%, p=0.006) than those with high AVC. During a follow-up (median: 3.8 years), the patients with low AVC had significantly higher risk of death from any cause (adjusted HR 1.60, 95% CI 1.02 to 2.52, p=0.04), mostly non-cardiac cause.

CONCLUSIONS

Patients with low AVC exhibit distinct clinical characteristics and a higher risk of long-term mortality compared with those with high AVC.

摘要

背景

一些患者尽管主动脉瓣钙化（AVC）程度较低，但仍患有严重的主动脉瓣狭窄（AS）。本研究比较了低AVC评分与高AVC评分的严重AS患者接受主动脉瓣置换术（AVR）后的临床特征和预后。

方法

本研究纳入了1002例有症状的重度退行性AS并接受AVR的韩国患者。我们在AVR前测量了AVC评分，将男性患者AVC评分<2000单位、女性患者AVC评分<1300单位定义为低AVC。排除患有二叶式或风湿性主动脉瓣疾病的患者。

结果

平均年龄为75.6±7.9岁，487例患者（48.6%）为女性。平均左心室射血分数为59.4%±10.4%，96例患者（9.6%）同时进行了冠状动脉血运重建。男性患者的主动脉瓣钙评分中位数为3122单位（四分位间距2249 - 4289单位），女性患者为1756单位（四分位间距1192 - 2572单位）。共有242例患者（24.2%）AVC较低；与高AVC患者相比，他们明显更年轻（73.5±8.7岁 vs 76.3±7.5岁，p<0.001），女性比例更高（59.5% vs 45.1%，p<0.001），且接受血液透析的比例更高（5.4% vs 1.8%，p = 0.006）。在随访期间（中位数：3.8年），低AVC患者任何原因导致的死亡风险显著更高（校正后风险比1.60，95%置信区间1.02至2.52，p = 0.04），主要是非心脏原因。