Onishi Hirokazu, Izumo Masaki, Ouchi Toru, Yuki Haruhito, Naganuma Toru, Nakao Tatsuya, Nakamura Sunao
Department of Cardiology, New Tokyo Hospital, Chiba, Japan.
Department of Cardiology, St. Marianna University School of Medicine, Kanagawa, Japan.
Front Cardiovasc Med. 2023 Aug 23;10:1259188. doi: 10.3389/fcvm.2023.1259188. eCollection 2023.
Information is scarce regarding the clinical implications of aortic valve replacement (AVR) for patients suffering from moderate mixed aortic valve disease (MAVD), characterized by a combination of moderate aortic stenosis (AS) and regurgitation (AR). The objective of this retrospective study was to explore the clinical effects of AVR in individuals with moderate MAVD.
We examined the clinical data from patients with moderate MAVD and preserved left ventricular ejection fraction, who had undergone echocardiography in the period spanning from 2010 to 2018. Moderate AS was defined as aortic valve area index of 0.60-0.85 cm/m and peak velocity of 3.0-4.0 m/s. Moderate AR was defined as a vena contracta width of 3.0-6.0 mm. The primary endpoint was a composite of all-cause death and heart failure hospitalization.
Among 88 patients (mean age, 74.4 ± 6.8 years; 48.9%, men), 44 (50.0%) required AVR during a median follow-up period of 3.3 years (interquartile range, 0.5-4.9). Mean values of specific aortic valve variables are as follows: aortic valve area index, 0.64 ± 0.04 cm/m; peak velocity, 3.40 ± 0.30 m/s; and vena contracta width, 4.1 ± 0.7 mm. The primary endpoint occurred in 32 (36.4%) patients during a median follow-up duration of 5.3 years (interquartile range, 3.2-8.0). Multivariable analysis revealed that AVR was significantly associated with the endpoint (hazard ratio, 0.248; 95% confidence interval, 0.107-0.579; = 0.001) after adjusting for age, B-type natriuretic peptide, and the Charlson comorbidity index. Patients who underwent AVR during follow-up had significantly lower incidence rates of the endpoint than those managed with medical treatment (10.2% vs. 44.1% at 5 years; < 0.001).
Approximately half of the patients diagnosed with moderate MAVD eventually necessitated AVR throughout the period of observation, leading to positive clinical results. Vigilant tracking of these patients and watchful monitoring for signs requiring AVR during this time frame are essential.
关于主动脉瓣置换术（AVR）对患有中度混合性主动脉瓣疾病（MAVD）患者的临床意义的信息很少，MAVD的特征是中度主动脉瓣狭窄（AS）和反流（AR）并存。这项回顾性研究的目的是探讨AVR对中度MAVD患者的临床效果。
我们检查了2010年至2018年期间接受超声心动图检查的中度MAVD且左心室射血分数保留的患者的临床数据。中度AS定义为主动脉瓣面积指数为0.60 - 0.85 cm/m²且峰值流速为3.0 - 4.0 m/s。中度AR定义为缩流颈宽度为3.0 - 6.0 mm。主要终点是全因死亡和心力衰竭住院的复合终点。
在88例患者（平均年龄74.4±6.8岁；48.9%为男性）中，44例（50.0%）在中位随访期3.3年（四分位间距0.5 - 4.9年）期间需要进行AVR。特定主动脉瓣变量的平均值如下：主动脉瓣面积指数0.64±0.04 cm/m²；峰值流速3.40±0.30 m/s；缩流颈宽度4.1±0.7 mm。在中位随访时长5.3年（四分位间距3.2 - 8.0年）期间，32例（36.4%）患者出现了主要终点。多变量分析显示，在调整年龄、B型利钠肽和查尔森合并症指数后，AVR与终点显著相关（风险比0.248；95%置信区间0.107 - 0.579；P = 0.001）。随访期间接受AVR的患者终点发生率显著低于接受药物治疗的患者（5年时分别为10.2%和44.1%；P < 0.001）。
在观察期内，约一半被诊断为中度MAVD的患者最终需要进行AVR，并取得了积极的临床结果。在此期间对这些患者进行密切跟踪并密切监测需要进行AVR的体征至关重要。
