Department for Cardiac Surgery, University Clinical Centre of Serbia, 11000 Belgrade, Serbia.
Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia.
Medicina (Kaunas). 2024 Sep 14;60(9):1503. doi: 10.3390/medicina60091503.
: The aim of this study was to estimate the prevalence of silent coronary artery disease (CAD) in asymptomatic patients with severe aortic stenosis (AS) and assess long-term prognosis in terms of major adverse cardiovascular event (MACE)-free survival. : This was a prospective study conducted at the Clinic for Cardiac Surgery, University Clinical Center of Serbia, in asymptomatic patients with severe AS, normal LVEF and stress test without signs of myocardial ischemia. Adverse cardiovascular events (cardiac death, myocardial infarction and any hospitalization due to heart disease) was monitored during one year of follow up. : A total of 116 asymptomatic patients with severe AS were included in the study. The average age was 67.3 ± 9.6 years, and 56.9% of patients were men. The most common cause of AS was degenerative valvular disease (83.5%). The incidence of significant CAD was 30 out of 116 patients (25.9%). The median Society for Thoracic Surgeons (STS) predicted risk of mortality score was 1.62% (25th to 75th percentile: 1.15-2.76%). The overall mean gradient across aortic valve (Pmean) was 52.30 mmHg ± 12.16, and the mean indexed AVA (AVAi) was 0.37 ± 0.09 cm/m. The mean LVEF was 68.40% ± 8.01%. Early surgery for aortic valve replacement was performed in 55 patients (55.2%), while 52 (44.8%) patients received conservative treatment. Twenty-two patients (42.3%) in the conservative treatment group underwent surgery during follow up. There were a total of 44 (37.9%) patients with MACE during one year of follow up. Univariate Cox regression analyses identified the following significant risk factors for MACE-free survival: presence of CAD and early conservative treatment ( = 0.004), age ( = 0.003), diabetes mellitus ( = 0.016) and STS score ( = 0.039). According to multivariate analysis, the presence of CAD with early conservative treatment was the most important predictor of MACE-free survival in asymptomatic patients with severe aortic stenosis ( ≤ 0.001). : Early surgery for aortic valve replacement in asymptomatic patients with severe AS and concomitant CAD is beneficial for long-term survival.
: 本研究旨在评估无症状严重主动脉瓣狭窄（AS）患者中无症状性冠状动脉疾病（CAD）的患病率，并评估主要不良心血管事件（MACE）无事件生存率的长期预后。 : 这是一项在塞尔维亚临床中心心脏外科诊所进行的前瞻性研究，纳入了无症状性严重 AS、正常左心室射血分数和无心肌缺血迹象的应激试验患者。在 1 年的随访期间，监测不良心血管事件（心源性死亡、心肌梗死和任何因心脏病住院）。 : 共纳入 116 例无症状性严重 AS 患者。平均年龄为 67.3 ± 9.6 岁，56.9%的患者为男性。AS 最常见的病因是退行性瓣膜病（83.5%）。有 30 例（25.9%）患者存在显著 CAD。美国胸外科医师学会（STS）预测死亡率评分中位数为 1.62%（25%至 75%：1.15-2.76%）。主动脉瓣跨瓣平均压力（Pmean）总体均值为 52.30 mmHg ± 12.16，平均主动脉瓣环面积指数（AVAi）为 0.37 ± 0.09 cm/m。平均左心室射血分数为 68.40% ± 8.01%。55 例（55.2%）患者早期行主动脉瓣置换术，52 例（44.8%）患者接受保守治疗。保守治疗组中有 22 例（42.3%）患者在随访期间行手术治疗。在 1 年的随访期间，共有 44 例（37.9%）患者发生 MACE。单因素 Cox 回归分析确定了无 MACE 生存的以下显著危险因素：CAD 存在和早期保守治疗（ = 0.004）、年龄（ = 0.003）、糖尿病（ = 0.016）和 STS 评分（ = 0.039）。多因素分析显示，无症状严重 AS 合并 CAD 患者中，CAD 伴早期保守治疗是 MACE 无事件生存的最重要预测因素（ ≤ 0.001）。 : 早期行主动脉瓣置换术治疗无症状性严重 AS 合并 CAD 的患者，有利于长期生存。
