Damluji Abdulla A, Bernacki Gwen, Afilalo Jonathan, Lyubarova Radmila, Orkaby Ariela R, Kwak Min Ji, Hummel Scott, Kirkpatrick James N, Maurer Mathew S, Wenger Nanette, Rich Michael W, Kim Dae Hyun, Wang Roberta Y, Forman Daniel E, Krishnaswami Ashok
Inova Heart and Vascular Institute, Inova Center of Outcomes Research, Falls Church, Virginia, USA.
Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
JACC Adv. 2024 Apr;3(4). doi: 10.1016/j.jacadv.2024.100877. Epub 2024 Apr 8.
Calcific aortic stenosis can be considered a model for geriatric cardiovascular conditions due to a confluence of factors. The remarkable technological development of transcatheter aortic valve replacement was studied initially on older adult populations with prohibitive or high-risk for surgical valve replacement. Through these trials, the cardiovascular community has recognized that stratification of these chronologically older adults can be improved incrementally by invoking the concept of frailty and other geriatric risks. Given the complexity of the aging process, stratification by chronological age should only be the initial step but is no longer sufficient to optimally quantify cardiovascular and noncardiovascular risk. In this review, we employ a geriatric cardiology lens to focus on the diagnosis and the comprehensive management of aortic stenosis in older adults to enhance shared decision-making with patients and their families and optimize patient-centered outcomes. Finally, we highlight knowledge gaps that are critical for future areas of study.
由于多种因素的共同作用，钙化性主动脉瓣狭窄可被视为老年心血管疾病的一个模型。经导管主动脉瓣置换术的显著技术发展最初是在因手术瓣膜置换存在禁忌或高风险的老年人群中进行研究的。通过这些试验，心血管领域已经认识到，通过引入衰弱概念和其他老年风险因素，可以逐步改进对这些按年龄划分的老年人的分层。鉴于衰老过程的复杂性，按年龄分层仅应作为初始步骤，但已不足以最佳地量化心血管和非心血管风险。在本综述中，我们采用老年心脏病学视角，专注于老年人主动脉瓣狭窄的诊断和综合管理，以加强与患者及其家属的共同决策，并优化以患者为中心的治疗结果。最后，我们强调了对未来研究领域至关重要的知识空白。
