Springhetti Paolo, Tomaselli Michele, Portolan Leonardo, Penso Marco, Pizzini Jessica, Leonardi Denis, Clement Alexandra, Ciceri Luca, Radu Noela, Benzoni Giorgia, Scarsini Roberto, Ribichini Flavio, Muraru Denisa, Benfari Giovanni, Badano Luigi P
Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy; Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy.
Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy.
J Am Soc Echocardiogr. 2025 Aug;38(8):643-654. doi: 10.1016/j.echo.2025.02.017. Epub 2025 Mar 8.
While left ventricular stroke volume (SV) is commonly used to define flow status in patients with aortic valve stenosis (AS), flow rate (FR) serves as a more precise descriptor of blood flow. However, evidence regarding the prognostic significance and determinates of transaortic FR, specifically in patients with a moderate AS, is limited.
We aimed to evaluate the association of transaortic FR with outcomes in patients with moderate AS.
We included 292 outpatients (mean age, 80 ± 9 years; 45% women) with moderate AS (aortic valve area, 1-1.5 cm) and complete clinical evaluation. Transaortic FR was calculated using the derivation-method (FR) and validated in 90 random patients in whom transaortic FR was also directly calculated as SV/ejection time (FR). The primary study end point was a composite of all-cause mortality and hospitalization for heart failure (HHF).
After median follow-up of 19.3 (interquartile range, 12.3-26.0) months, 73 patients reached the primary end point (22 HHF and 51 deaths). Patients who met the primary end point had a lower transaortic FR value compared to those not experiencing events (201 ± 47 mL/sec vs 225 ± 48 mL/sec). The transaortic FR presented excellent correlation with FR (R = 0.93, P < .0001). The transaortic FR threshold for excess risk of adverse outcome was approximately 218 mL/sec. Below this value, the risk increased steeply, showing no plateau effect. Several factors were independently associated with transaortic FR < 218 mL/sec, including female sex, renal insufficiency, previous myocardial infarction, SV index, and at least moderate tricuspid regurgitation (all P < .02). After comprehensive adjustment, transaortic FR < 218 mL/sec turned out to be independently associated with events (adjusted hazard ratio, 2.17 [95% CI, 1.14-4.12], P = .018).
Transaortic FR < 218 mL/sec is independently associated with adverse outcomes in moderate AS. Further research is needed to determine whether patients with moderate AS and impaired transaortic FR would benefit from more intensive monitoring or earlier aortic valve replacement.
虽然左心室每搏输出量（SV）常用于定义主动脉瓣狭窄（AS）患者的血流状态，但流速（FR）是更精确的血流描述指标。然而，关于经主动脉FR的预后意义及决定因素，特别是中度AS患者的相关证据有限。
我们旨在评估中度AS患者经主动脉FR与预后的相关性。
我们纳入了292例中度AS（主动脉瓣面积为1 - 1.5平方厘米）的门诊患者（平均年龄80±9岁；45%为女性），并进行了完整的临床评估。经主动脉FR采用推导法（FR）计算，并在90例随机患者中进行验证，这些患者的经主动脉FR也直接计算为SV/射血时间（FR）。主要研究终点是全因死亡率和心力衰竭住院（HHF）的复合终点。
在中位随访19.3（四分位间距为12.3 - 26.0）个月后，73例患者达到主要终点（22例HHF和51例死亡）。达到主要终点的患者与未发生事件的患者相比，经主动脉FR值更低（201±47毫升/秒对225±48毫升/秒）。经主动脉FR与FR呈现出极好的相关性（R = 0.93，P <.0001）。不良结局额外风险的经主动脉FR阈值约为218毫升/秒。低于此值，风险急剧增加，无平台效应。几个因素与经主动脉FR < 218毫升/秒独立相关，包括女性、肾功能不全、既往心肌梗死、SV指数以及至少中度三尖瓣反流（所有P <.02）。经过全面调整后，经主动脉FR < 218毫升/秒被证明与事件独立相关（调整后风险比为2.17 [95%可信区间为1.14 - 4.12]，P =.018）。
经主动脉FR < 218毫升/秒与中度AS患者的不良结局独立相关。需要进一步研究以确定中度AS且经主动脉FR受损的患者是否会从更强化的监测或更早的主动脉瓣置换中获益。
