Solomon Matthew D, Go Alan S, Leong Thomas, Garcia Elisha, Le Kathy, Philip Femi, McNulty Edward, Mishell Jacob, Rassi Andrew N, Lange David C, Lee Catherine, DeMaria Anthony, Nishimura Rick, Ambrosy Andrew P
Center for Health Systems Research, Sutter Health, Emeryville, California, USA; Division of Cardiology, California Pacific Medical Center, Sutter Health, San Francisco, California, USA.
Kaiser Permanente Northern California Division of Research, Oakland, California, USA; Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, USA; Departments of Epidemiology, Biostatistics and Medicine, University of California, San Francisco, San Francisco, California, USA.
JACC Adv. 2025 Jul 21;4(8):101962. doi: 10.1016/j.jacadv.2025.101962.
The relationship between aortic stenosis (AS) severity, AS-related symptoms, and clinical outcomes is poorly understood.
The purpose of this study was to evaluate whether potential AS-related symptoms at diagnosis are associated with outcomes, including death and AS-related hospitalization.
In this retrospective cohort study from a large, integrated health care system serving >4.5 M individuals, we applied validated natural language processing algorithms to echocardiogram reports to identify physician-assessed AS severity and potential AS-related symptoms (eg, chest pain, syncope, dyspnea, worsening heart failure) via diagnosis codes and natural language processing-applied physician notes. Of 602,821 adults with echocardiograms from 2010 to 2019, we identified 40,333 adults diagnosed with AS and applied Cox models to examine associations between AS-related symptoms, AS severity, and clinical outcomes over a median follow-up of 2.2 years.
Most patients with AS had potential AS-related symptoms (mild: 80%, mild-moderate: 77%, moderate: 77%, moderate-severe: 85%, severe: 87%). Symptomatic patients were older (mean age 78 vs 75 years; P < 0.01), more often female (51% vs 47%; P < 0.01), and had greater comorbidity burden. After multivariable adjustment, symptom status strongly predicted risk. Patients with symptomatic moderate AS had a similar risk to those with severe AS without symptoms (adjusted HR: 1.77 [95% CI: 1.65-1.91] vs 1.81 [95% CI: 1.51-2.17] for death, P = 0.81; aHR: 2.27 [95% CI: 2.13-2.41] vs 2.40 [95% CI: 2.08-2.77] for AS-related hospitalization, P = 0.42).
These findings suggest that symptom status, independent of AS severity, is a key risk factor for adverse outcomes. Further research is needed to assess the benefits of early intervention in these high-risk groups.
主动脉瓣狭窄（AS）的严重程度、与AS相关的症状和临床结局之间的关系尚不清楚。
本研究旨在评估诊断时潜在的与AS相关的症状是否与包括死亡和与AS相关的住院在内的结局相关。
在这项来自一个为超过450万人提供服务的大型综合医疗保健系统的回顾性队列研究中，我们应用经过验证的自然语言处理算法对超声心动图报告进行分析，以通过诊断编码和应用自然语言处理的医生记录来确定医生评估的AS严重程度和潜在的与AS相关的症状（如胸痛、晕厥、呼吸困难、心力衰竭加重）。在2010年至2019年有超声心动图检查的602821名成年人中，我们确定了40333名被诊断为AS的成年人，并应用Cox模型来研究在中位随访2.2年期间与AS相关的症状、AS严重程度和临床结局之间的关联。
大多数AS患者有潜在的与AS相关的症状（轻度：80%，轻度-中度：77%，中度：77%，中度-重度：85%，重度：87%）。有症状的患者年龄更大（平均年龄78岁对75岁；P<0.01），女性更常见（51%对47%；P<0.01），且合并症负担更重。经过多变量调整后，症状状态强烈预测风险。有症状的中度AS患者与无症状的重度AS患者风险相似（死亡的调整后HR：1.77[95%CI：1.65-1.91]对1.81[95%CI：1.51-2.17]，P=0.81；与AS相关住院的aHR：2.27[95%CI：2.13-2.41]对2.40[95%CI：2.08-2.77]，P=0.42）。
这些发现表明，症状状态独立于AS严重程度，是不良结局的关键危险因素。需要进一步研究来评估对这些高危人群进行早期干预的益处。
