低梯度重度主动脉瓣狭窄：来自CURRENT AS注册研究-2的见解
Low-Gradient Severe Aortic Stenosis: Insights From the CURRENT AS Registry-2.
作者信息
Taniguchi Tomohiko, Morimoto Takeshi, Takeji Yasuaki, Shirai Shinichi, Ando Kenji, Tabata Hiroyuki, Yamamoto Ko, Murai Ryosuke, Osakada Kohei, Sakamoto Hiroki, Tada Tomohisa, Murata Koichiro, Obayashi Yuki, Amano Masashi, Kitai Takeshi, Izumi Chisato, Toyofuku Mamoru, Kanamori Norio, Miyake Makoto, Nakayama Hiroyuki, Izuhara Masayasu, Nagao Kazuya, Nakatsuma Kenji, Furukawa Yutaka, Inoko Moriaki, Kimura Masahiro, Ishii Mitsuru, Usami Shunsuke, Nakazeki Fumiko, Shirotani Manabu, Inuzuka Yasutaka, Ono Koh, Minatoya Kenji, Kimura Takeshi
机构信息
Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan.
Department of Clinical Epidemiology, Hyogo Medical University, Nishinomiya, Japan.
出版信息
JACC Cardiovasc Interv. 2025 Feb 24;18(4):471-487. doi: 10.1016/j.jcin.2024.09.044. Epub 2024 Dec 18.
BACKGROUND
Low-gradient (LG) aortic stenosis (AS) has not been fully characterized compared with high-gradient (HG) AS in terms of cardiac damage, frailty, aortic valve calcification, and clinical outcomes.
OBJECTIVES
The aim of this study was to compare the clinical characteristics and outcomes between each hemodynamic type of LG AS and HG AS.
METHODS
The current study included 3,363 patients in the CURRENT AS (Contemporary outcomes after sURgery and medical tREatmeNT in patients with severe Aortic Stenosis) Registry-2 after excluding patients without indexed stroke volume or left ventricular ejection fraction (LVEF) data. Patients were divided into 4 groups (LG AS with reduced LVEF: n = 285; paradoxical low flow, low gradient [LFLG]: n = 220; normal flow, low gradient [NFLG]: n = 872; HG: n = 1,986).
RESULTS
Compared with HG AS, LG AS with reduced LVEF more often had cardiovascular comorbidities, advanced cardiac damage, and frailty with less severe valve calcification and paradoxical LFLG AS more often had atrial fibrillation, advanced cardiac damage, and frailty with less severe valve calcification, while NFLG AS had comparable cardiac damage and frailty with less severe valve calcification. Cumulative 3-year incidence of death or heart failure hospitalization was higher in LG AS with reduced LVEF and paradoxical LFLG than in HG AS. After adjusting for confounders, LG AS with reduced LVEF and paradoxical LFLG compared with HG AS were independently associated with higher risk for death or heart failure hospitalization (HR: 1.82; 95% CI: 1.49-2.23; P < 0.001; and HR: 1.43; 95% CI: 1.13-1.82; P = 0.003, respectively) but NFLG AS was not (HR: 1.03; 95% CI: 0.88-1.21; P = 0.68).
CONCLUSIONS
Clinical outcomes were significantly worse in LG AS with reduced LVEF and paradoxical LFLG AS and comparable in NFLG AS compared with HG AS.
背景
与高梯度（HG）主动脉瓣狭窄（AS）相比，低梯度（LG）AS在心脏损害、身体虚弱、主动脉瓣钙化和临床结局方面尚未得到充分描述。
目的
本研究旨在比较各血流动力学类型的LG AS和HG AS的临床特征及结局。
方法
本研究纳入了严重主动脉瓣狭窄患者手术和药物治疗当代结局（CURRENT AS）注册研究-2中的3363例患者，排除了没有校正每搏输出量或左心室射血分数（LVEF）数据的患者。患者被分为4组（LVEF降低的LG AS：n = 285；矛盾性低流量、低梯度[LFLG]：n = 220；正常流量、低梯度[NFLG]：n = 872；HG：n = 1986）。
结果
与HG AS相比，LVEF降低的LG AS更常伴有心血管合并症、严重心脏损害和身体虚弱，瓣膜钙化较轻；矛盾性LFLG AS更常伴有心房颤动、严重心脏损害和身体虚弱，瓣膜钙化较轻；而NFLG AS的心脏损害和身体虚弱程度相当，瓣膜钙化较轻。LVEF降低的LG AS和矛盾性LFLG的3年死亡或心力衰竭住院累积发生率高于HG AS。校正混杂因素后，与HG AS相比，LVEF降低的LG AS和矛盾性LFLG与死亡或心力衰竭住院的较高风险独立相关（HR：1.82；95%CI：1.49-2.23；P < 0.001；以及HR：1.43；95%CI：1.13-1.82；P = 0.003），但NFLG AS并非如此（HR：1.03；95%CI：0.88-1.21；P = 0.68）。
结论
与HG AS相比，LVEF降低的LG AS和矛盾性LFLG AS的临床结局明显更差，而NFLG AS的临床结局相当。
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