Kany Shinwan, Rämö Joel T, Playford David, Strange Geoff, Hou Cody, Jurgens Sean J, Nauffal Victor, Cunningham Jonathan W, Lau Emily S, Butte Atul J, Ho Jennifer E, Olgin Jeffrey E, Elmariah Sammy, Lindsay Mark E, Chan Yih-Kai, Stewart Simon, Ellinor Patrick T, Pirruccello James P
Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA; Department of Cardiology, University Heart and Vascular Center Hamburg-Eppendorf, Hamburg, Germany; Cardiovascular Research Center, Massachusetts General Hospital, Boston, Massachusetts, USA; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany.
Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA; Cardiovascular Research Center, Massachusetts General Hospital, Boston, Massachusetts, USA; Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (HiLIFE), University of Helsinki, Helsinki, Finland.
J Am Coll Cardiol. 2025 Apr 8;85(13):1387-1399. doi: 10.1016/j.jacc.2025.01.035.
Mild aortic stenosis (AS) is associated with adverse outcomes but is incompletely defined.
The purpose of this study was to examine the epidemiology of AV function measured without clinical indications.
We developed a deep learning model to measure aortic valve (AV) area, peak velocity, and mean gradient in velocity-encoded cardiac magnetic resonance imaging in 62,902 UK Biobank participants. Study findings were externally validated in NEDA (National Echo Database Australia), a clinical cohort of 365,870 people.
From measuring reference ranges of AV function in a healthy subcohort (n = 41,859), we observed a natural boundary between normal and abnormal AV hemodynamics (>95th percentile) that we refer to as "mild AS": peak velocity >1.65 m/s, mean gradient >4.9 mm Hg, or aortic valve area <2.1 cm (men) or <1.7 cm (women). In the full cohort, 3,676 (5.8%) participants met these novel criteria; the HR for a subsequent AV replacement for each severity category was 31.7 (mild AS), 522.4 (moderate AS), and 3,057.4 (severe AS), all P < 0.001. Over a mean 3.9 years of follow-up, those with mild AS also had a higher risk of atrial fibrillation (110 events; HR: 1.86; P = 1.4 × 10) and heart failure (70 events; HR: 2.37; P = 5.9 × 10) compared with those without AS. In NEDA, the 101,335 participants with mild AS identified with echocardiography using the same cardiac magnetic resonance imaging-defined criteria had increased all-cause mortality (HR: 1.25; 95% CI: 1.24-1.27).
We report a large-scale study of AV hemodynamics and identify a population threshold between normal and abnormal AV function. Mild AS, as defined by the proposed criteria, was linked to adverse outcomes in the UK Biobank and in NEDA.
轻度主动脉瓣狭窄（AS）与不良预后相关，但定义尚不完整。
本研究旨在探讨无临床指征情况下测量的主动脉瓣（AV）功能的流行病学情况。
我们开发了一种深度学习模型，用于测量62902名英国生物银行参与者的速度编码心脏磁共振成像中的主动脉瓣面积、峰值速度和平均梯度。研究结果在澳大利亚国家回声数据库（NEDA）这一包含365870人的临床队列中进行了外部验证。
通过测量健康亚组（n = 41859）中AV功能的参考范围，我们观察到正常与异常AV血流动力学之间的自然边界（>第95百分位数），我们将其称为“轻度AS”：峰值速度>1.65 m/s、平均梯度>4.9 mmHg或主动脉瓣面积<2.1 cm²（男性）或<1.7 cm²（女性）。在整个队列中，3676名（5.8%）参与者符合这些新标准；每个严重程度类别后续进行AV置换的风险比（HR）分别为31.7（轻度AS）、522.4（中度AS）和3057.4（重度AS），所有P < 0.001。在平均3.9年的随访中，与无AS者相比，轻度AS者发生心房颤动（110例事件；HR：1.86；P = 1.4×10⁻⁴）和心力衰竭（70例事件；HR：2.37；P = 5.9×10⁻⁵）的风险也更高。在NEDA中，使用相同的心脏磁共振成像定义标准通过超声心动图识别出的101335名轻度AS参与者全因死亡率增加（HR：1.25；95%置信区间：1.24 - 1.27）。
我们报告了一项关于AV血流动力学的大规模研究，并确定了正常与异常AV功能之间的人群阈值。根据所提出标准定义的轻度AS与英国生物银行和NEDA中的不良预后相关。
