主动脉瓣狭窄中的急性瓣膜综合征

Acute Valve Syndrome in Aortic Stenosis.

作者信息

Généreux Philippe, Pellikka Patricia A, Lindman Brian R, Pibarot Philippe, Garcia Santiago, Koulogiannis Konstantinos P, Rodriguez Evelio, Thourani Vinod H, Dobbles Michael, Giustino Gennaro, Sharma Rahul P, Cohen David J, Schwartz Allan, Leon Martin B, Gillam Linda D

机构信息

Department of Cardiology, Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, New Jersey, USA.

Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.

出版信息

Struct Heart. 2024 Oct 28;9(4):100377. doi: 10.1016/j.shj.2024.100377. eCollection 2025 Apr.

DOI:10.1016/j.shj.2024.100377

PMID:40321310

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12047511/

Abstract

BACKGROUND

To describe the impact of clinical presentation among patients with aortic stenosis (AS) undergoing aortic valve replacement (AVR).

METHODS

We analyzed a real-world dataset including patients from 29 US hospitals (egnite Database, egnite). Patients over 18 years old with moderate or greater AS undergoing AVR were included. Patients were classified into 3 groups according to the acuity and severity of clinical presentation prior to AVR: (i) asymptomatic, (ii) progressive signs and symptoms (progressive valve syndrome [PVS]), and (iii) acute or advanced signs and symptoms (acute valve syndrome [AVS]). Mortality and heart failure hospitalization after AVR were examined with Kaplan-Meier estimates, with results compared using the log-rank test.

RESULTS

Among 2,009,607 patients in our database, 17,838 underwent AVR (78.6% transcatheter AVR, 21.4% surgical AVR). Age was 76.5 ± 9.7 years, and 40.2% were female. Prior to AVR, 2504 (14.0%) were asymptomatic, 6116 (34.3%) presented with PVS, and 9218 (51.7%) presented with AVS. At 2 years, the estimated rate of mortality for asymptomatic, PVS, and AVS were 5.8% (4.6%-7.0%), 7.6% (6.7%-8.4%), and 17.5% (16.5%-18.5%), respectively, and the estimated rate of hospitalization with heart failure for asymptomatic, PVS, and AVS were 11.1% (9.5%-12.6%), 19.0% (17.8%-20.2%), and 41.5% (40.2%-42.8%), respectively. After adjustment, patients presenting with AVS had increased risk of mortality after AVR (hazard ratio, 2.2; 95% CI, 1.8-2.6).

CONCLUSIONS

From a large, real-world database of patients undergoing AVR for AS, most patients presented with AVS, which was associated with an increased risk of mortality and heart failure hospitalization.

摘要

背景

描述接受主动脉瓣置换术（AVR）的主动脉瓣狭窄（AS）患者的临床表现影响。

方法

我们分析了一个来自美国29家医院的真实世界数据集（egnite数据库，egnite）。纳入年龄在18岁以上、中度或重度AS且接受AVR的患者。根据AVR术前临床表现的急性程度和严重程度将患者分为3组：（i）无症状，（ii）进行性体征和症状（进行性瓣膜综合征[PVS]），以及（iii）急性或晚期体征和症状（急性瓣膜综合征[AVS]）。采用Kaplan-Meier估计法检查AVR术后的死亡率和心力衰竭住院率，并使用对数秩检验比较结果。

结果

在我们数据库中的2,009,607例患者中，17,838例接受了AVR（经导管AVR占78.6%，外科AVR占21.4%）。年龄为76.5±9.7岁，40.2%为女性。在AVR术前，2504例（14.0%）无症状，6116例（34.3%）表现为PVS，9218例（51.7%）表现为AVS。在2年时，无症状、PVS和AVS的估计死亡率分别为5.8%（4.6%-7.0%）、7.6%（6.7%-8.4%）和17.5%（16.5%-18.5%），无症状、PVS和AVS的心力衰竭住院估计率分别为11.1%（9.5%-12.6%）、19.0%（17.8%-20.2%）和41.5%（40.2%-42.8%）。调整后，表现为AVS的患者在AVR术后死亡风险增加（风险比，2.2；95%CI，1.8-2.6）。