Miyahara Daisuke, Izumo Masaki, Sato Yukio, Shoji Tatsuro, Murata Risako, Oda Ryutaro, Okuno Taishi, Kuwata Shingo, Akashi Yoshihiro J
Department of Cardiology, St Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-ku, Kawasaki 216-8511, Japan.
Eur Heart J Open. 2024 Mar 6;4(2):oeae018. doi: 10.1093/ehjopen/oeae018. eCollection 2024 Mar.
Current evidence on the prognostic value of exercise stress echocardiography (ESE) in asymptomatic patients with low-gradient severe aortic stenosis (AS) is limited. Therefore, this study aimed to elucidate its prognostic implications for patients with low-gradient severe AS and determine the added value of ESE in risk stratification for this population.
This retrospective observational study included 122 consecutive asymptomatic patients with either moderate [mean pressure gradient (MPG) < 40 mmHg and aortic valve area (AVA) 1.0-1.5 cm] or low-gradient severe (MPG < 40 mmHg and AVA < 1.0 cm) AS and preserved left ventricular ejection fraction (≥50%) who underwent ESE. All patients were followed up for AS-related events. Of 143 patients, 21 who met any exclusion criteria, including early interventions, were excluded, and 122 conservatively managed patients [76.5 (71.0-80.3) years; 48.3% male] were included in this study. During a median follow-up period of 989 (578-1571) days, 64 patients experienced AS-related events. Patients with low-gradient severe AS had significantly lower event-free survival rates than those with moderate AS (log-rank test, < 0.001). Multivariable Cox regression analysis showed that the mitral /' ratio during exercise was independently associated with AS-related events (hazard ratio = 1.075, < 0.001) in patients with low-gradient severe AS.
This study suggests that asymptomatic patients with low-gradient severe AS have worse prognoses than those with moderate AS. Additionally, the mitral /' ratio during exercise is a useful parameter for risk stratification in patients with low-gradient severe AS.
目前关于运动负荷超声心动图（ESE）对无症状的低跨瓣压差重度主动脉瓣狭窄（AS）患者的预后价值的证据有限。因此，本研究旨在阐明其对低跨瓣压差重度AS患者的预后意义，并确定ESE在该人群风险分层中的附加价值。
这项回顾性观察性研究纳入了122例连续的无症状患者，这些患者患有中度（平均跨瓣压差[MPG]<40 mmHg且主动脉瓣面积[AVA]为1.0 - 1.5 cm）或低跨瓣压差重度（MPG<40 mmHg且AVA<1.0 cm）AS且左心室射血分数保留（≥50%），并接受了ESE检查。所有患者均接受与AS相关事件的随访。在143例患者中，21例符合任何排除标准（包括早期干预）的患者被排除，122例接受保守治疗的患者[年龄76.5（71.0 - 80.3）岁；男性占48.3%]被纳入本研究。在中位随访期989（578 - 1571）天期间，64例患者发生了与AS相关的事件。低跨瓣压差重度AS患者的无事件生存率显著低于中度AS患者（对数秩检验，<0.001）。多变量Cox回归分析显示，运动时二尖瓣/‘比值与低跨瓣压差重度AS患者的AS相关事件独立相关（风险比 = 1.075，<0.001）。
本研究表明，无症状的低跨瓣压差重度AS患者的预后比中度AS患者更差。此外，运动时二尖瓣/‘比值是低跨瓣压差重度AS患者风险分层的有用参数。
