ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy.
University of Medicine and Pharmacy Carol Davila.
J Cardiovasc Med (Hagerstown). 2024 Apr 1;25(4):259-270. doi: 10.2459/JCM.0000000000001591. Epub 2024 Mar 1.
Aortic stenosis is the most prevalent valvular heart disease requiring intervention, especially in the elderly population. Surgical aortic valve replacement and transcatheter aortic valve implantation (TAVI) are well established treatment options for symptomatic patients with severe aortic stenosis, as they provide a significant survival benefit. Aortic stenosis may have an important impact on patients' quality of life (QoL). However, advanced age, comorbidities and frailty may limit the beneficial effect of aortic stenosis interventions in terms of QoL. Current guidelines mention the importance of frailty and avoiding the futility of interventions, but lack specific indications about decision-making. Also, there are limited data on how to specifically assess QoL in aortic stenosis patients since the most used questionnaires are validated in different populations (i.e. heart failure). The aim of this review is to summarize all the available tools for QoL assessment in patients with aortic stenosis; to report current evidence on the impact of TAVI on QoL; and to discuss the role of frailty and comorbidities in this setting.
主动脉瓣狭窄是最常见的需要介入治疗的瓣膜性心脏病，尤其是在老年人群中。对于有症状的严重主动脉瓣狭窄患者，外科主动脉瓣置换术和经导管主动脉瓣植入术（TAVI）是成熟的治疗选择，因为它们提供了显著的生存获益。主动脉瓣狭窄可能对患者的生活质量（QoL）有重要影响。然而，高龄、合并症和虚弱可能会限制主动脉瓣狭窄干预在 QoL 方面的有益效果。目前的指南提到了虚弱的重要性和避免干预的无效性，但缺乏关于决策的具体指征。此外，由于最常用的问卷在不同人群（即心力衰竭）中得到验证，因此在主动脉瓣狭窄患者中评估 QoL 的具体数据有限。本综述的目的是总结所有可用于评估主动脉瓣狭窄患者 QoL 的工具；报告 TAVI 对 QoL 的影响的现有证据；并讨论在这种情况下虚弱和合并症的作用。
