Juhász D, Vecsey-Nagy M, Jermendy Á L, Szilveszter B, Simon J, Vattay B, Boussoussou M, Dávid D, Maurovich-Horvát P, Merkely B, Apor A, Molnár L, Dósa E, Rakovics M, Johnson J, Manouras A, Nagy A I
Heart and Vascular Centre, Semmelweis University, 68. Varosmajor u, 1122-Budapest, Hungary.
Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA.
Eur Heart J Cardiovasc Imaging. 2025 Jan 31;26(2):287-298. doi: 10.1093/ehjci/jeae276.
Low-gradient (LG) aortic stenosis (AS) poses a diagnostic challenge. Aortic valve calcium score (AVCS) assessment has emerged as a complementary diagnostic method when echocardiography provides discordant results. However, the diagnostic and prognostic values of AVCS in LGAS have not been thoroughly studied. Our aims in this study were to investigate the prognostic importance of AVCS in LGAS and to assess whether symptomatic patients with LGAS and low AVCS may benefit from aortic valve intervention (AVI).
A total of 327 symptomatic patients (78.5 ± 7.3 years, 51% women) with severe AS defined by the aortic valve area who underwent computed tomography for transcatheter aortic valve intervention (TAVI) planning were enrolled. AVCS was measured. AVCS < 2000AU in men and < 1200 AU in women was considered a low AVCS. A total of 243 patients had high gradient (HG) and 84 had LGAS. A low AVCS was present in 25 (10%) patients with HG and 34 (40%) with LGAS. Over a median follow-up period of 4.9 years, 194 deaths occurred. In multivariate analysis, AVCS was a significant independent predictor of all-cause mortality among patients with HGAS [adjusted hazard ratio (aHR): 2.317; CI: 1.104-4.861; P = 0.026] but not among those with LGAS (aHR: 0.848; CI: 0.434-1.658; P = 0.630). After propensity score matching between patients who underwent AVI and those who were medically treated, AVI (94% TAVI) was a significant and independent predictor of survival among LGAS patients with a low AVCS even after adjustment for clinical variables (aHR: 0.102, CI: 0.028-0.369; P < 0.001).
The prevalence of a low AVCS is much higher in patients with LGAS than in those with HGAS. In patients with symptomatic severe LGAS, a low AVCS does not entail a better prognosis. AVI is equally beneficial in LGAS patients with a high or low AVCS, similarly to those with HGAS.
低梯度（LG）主动脉瓣狭窄（AS）带来了诊断挑战。当超声心动图结果不一致时，主动脉瓣钙化评分（AVCS）评估已成为一种辅助诊断方法。然而，AVCS在LGAS中的诊断和预后价值尚未得到充分研究。本研究的目的是探讨AVCS在LGAS中的预后重要性，并评估有症状的LGAS且AVCS低的患者是否可能从主动脉瓣干预（AVI）中获益。
共有327例有症状的严重AS患者（年龄78.5±7.3岁，51%为女性）纳入研究，这些患者因经导管主动脉瓣置换术（TAVI）规划而接受了计算机断层扫描，通过主动脉瓣面积定义为严重AS。测量了AVCS。男性AVCS<2000AU且女性AVCS<1200AU被认为是低AVCS。共有243例患者为高梯度（HG），84例为LGAS。25例（10%）HG患者和34例（40%）LGAS患者存在低AVCS。在中位随访期4.9年期间，发生了194例死亡。在多变量分析中，AVCS是HGAS患者全因死亡率的显著独立预测因素[调整后风险比（aHR）：2.317；置信区间（CI）：1.104 - 4.861；P = 0.026]，但在LGAS患者中不是（aHR：0.848；CI：0.434 - 1.658；P = 0.630）。在接受AVI的患者和接受药物治疗的患者之间进行倾向评分匹配后，即使在调整临床变量后，AVI（94%为TAVI）仍是LGAS且AVCS低的患者生存的显著独立预测因素（aHR：0.102，CI：0.028 - 0.369；P < 0.001）。
LGAS患者中低AVCS的患病率远高于HGAS患者。有症状的严重LGAS患者中，低AVCS并不意味着更好的预后。AVI对AVCS高或低的LGAS患者同样有益，与HGAS患者类似。
