Généreux Philippe, Amoroso Nicholas S, Thourani Vinod H, Rodriguez Evelio, Sharma Rahul P, Pinto Duane S, Kwon Michelle, Dobbles Michael, Pellikka Patricia A, Gillam Linda D
Department of Cardiovascular Medicine, Morristown Medical Center, Morristown, New Jersey, USA.
Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA.
JACC Adv. 2024 Sep 6;3(10):101228. doi: 10.1016/j.jacadv.2024.101228. eCollection 2024 Oct.
Aortic valve replacement (AVR) is indicated in patients with severe aortic regurgitation (AR); however, certain clinical factors may identify patients with less-than-severe AR at high mortality risk if untreated.
The authors sought to characterize key associations with mortality across the spectrum of AR in patients not treated with AVR from a large, contemporary database.
We analyzed patients >18 years of age with documented AR assessment in a deidentified real-world data set from 27 U.S. institutions with appropriate permissions (egnite Database, egnite, Inc). Diagnosed AR severity was extracted from echocardiographic reports using a natural language processing-based algorithm. Cox multivariable analysis modeled the impact of key factors on untreated mortality according to AR severity.
In total, 81,378 patients were included for analysis. Hazard ratios for mortality were 1.26 (95% CI: 1.18-1.35) and 2.37 (95% CI: 1.96-2.87) for moderate and severe AR, respectively. Other significant associations included left ventricular (LV) ejection fraction ≤55% (1.09 [95% CI: 1.02-1.15]), LV dilation (1.34 [95% CI: 1.21-1.48]), left atrial dilation (1.09 [95% CI: 1.03-1.16]), atrial fibrillation (1.11 [1.04-1.17]), and elevated B-type natriuretic peptide/N-terminal pro-B-type natriuretic peptide (1.71 [95% CI: 1.60-1.84]). Modeled mortality risk increased with the presence of these key factors both alone and in combination.
In patients with untreated AR, LV remodeling, left atrial remodeling, and other markers of cardiac damage are associated with substantial mortality risk, both for severe and moderate AR. Further study is needed to determine whether AVR is warranted in patients with less-than-severe AR with at-risk factors.
对于重度主动脉瓣反流（AR）患者，需进行主动脉瓣置换术（AVR）；然而，某些临床因素可能会识别出未经治疗则死亡风险较高的非重度AR患者。
作者试图从一个大型当代数据库中，对未接受AVR治疗的AR患者全范围内与死亡率相关的关键因素进行特征描述。
我们分析了来自美国27家机构的一个经过身份识别处理的真实世界数据集中年龄大于18岁且有AR评估记录的患者（egnite数据库，egnite公司）。使用基于自然语言处理的算法从超声心动图报告中提取诊断的AR严重程度。Cox多变量分析根据AR严重程度对关键因素对未治疗死亡率的影响进行建模。
总共纳入81378例患者进行分析。中度和重度AR患者的死亡风险比分别为1.26（95%CI：1.18 - 1.35）和2.37（95%CI：1.96 - 2.87）。其他显著相关因素包括左心室（LV）射血分数≤55%（1.09[95%CI：1.02 - 1.15]）、左心室扩张（1.34[95%CI：1.21 - 1.48]）、左心房扩张（1.09[95%CI：1.03 - 1.16]）、心房颤动（1.11[1.04 - 1.17]）以及B型利钠肽/NT - 前体B型利钠肽升高（1.71[95%CI：1.60 - 1.84]）。这些关键因素单独或联合存在时，建模的死亡风险均增加。
在未经治疗的AR患者中，左心室重构、左心房重构以及其他心脏损伤标志物与重度和中度AR患者的高死亡风险相关。需要进一步研究以确定对于有风险因素的非重度AR患者是否有必要进行AVR。
