Malahfji Maan, Nguyen Duc T, Bhugra Priyanka, Crudo Valentina, Saeed Mujtaba, Goel Sachin S, Reardon Michael J, Kleiman Neal S, Zoghbi William A, Graviss Edward A, Shah Dipan J
Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas, USA.
Department of Pathology and Genomic Medicine, Houston Methodist Hospital Research Institute, Houston, Texas, USA.
JACC Cardiovasc Imaging. 2025 Jul 22. doi: 10.1016/j.jcmg.2025.04.010.
A recently proposed staging system for cardiac structural and functional abnormalities demonstrated incremental prognostic value in aortic stenosis.
The authors investigate a staging system incorporating cardiac magnetic resonance (CMR) in moderate or severe aortic regurgitation (AR).
Patients prospectively enrolled in DEBAKEY-CMR (DeBakey Cardiovascular Magnetic Resonance Study; NCT04281823) between 2009 and 2020 who had moderate or severe AR by CMR were studied. We excluded patients with a primary cardiomyopathy (eg, hypertrophic cardiomyopathy, amyloidosis, sarcoidosis) or prior valve intervention. The stages were defined as stage 0: no cardiac remodeling; stage 1: left ventricular (LV) remodeling; stage 2: mitral valve or left atrial abnormalities; and stage 3: right heart remodeling. The outcome was all-cause mortality.
The authors studied 395 patients, median age 62 years (Q1-Q3: 51-72 years); 79.2% were male, and 25.8% had bicuspid aortic valve. Thirty-two patients (8.10%) were classified as stage 0, 146 (37.0%) as stage 1, 77 (19.5%) as stage 2, and 140 (35.4%) as stage 3. Over a mean follow-up period of 3.9 ± 2.9 years, the annualized mortality rate was 0.68% per year in stage 0, 2.25% per year in stage 1, 3.76% per year in stage 2, and 7.25% per year in stage 3 (P for trend of mortality <0.001). The extent of cardiac remodeling was independently associated with increased hazard for mortality (adjusted HR: 1.69 per increment of stage [95% CI: 1.28-2.23]; P < 0.001) after adjusting for regurgitation severity, aortic valve replacement (AVR), and EuroSCORE II (European System for Cardiac Operative Risk Evaluation). Patients with right heart remodeling had the highest hazard for events.
A cardiac remodeling staging system incorporating CMR findings provides incremental prognostication in AR after adjusting for surgical risk, AVR, and regurgitation severity. Right heart remodeling in AR was associated with the highest mortality. Further research can determine whether the staging system could aid in guiding patient management and the timing of intervention.
最近提出的一种用于心脏结构和功能异常的分期系统在主动脉瓣狭窄中显示出递增的预后价值。
作者研究了一种将心脏磁共振成像（CMR）纳入中度或重度主动脉瓣关闭不全（AR）的分期系统。
对2009年至2020年间前瞻性纳入DEBAKEY-CMR（德巴基心血管磁共振研究；NCT04281823）且经CMR诊断为中度或重度AR的患者进行研究。我们排除了原发性心肌病（如肥厚型心肌病、淀粉样变性、结节病）或既往有瓣膜干预的患者。分期定义为：0期：无心脏重塑；1期：左心室（LV）重塑；2期：二尖瓣或左心房异常；3期：右心重塑。结局为全因死亡率。
作者研究了395例患者，中位年龄62岁（四分位间距：51 - 72岁）；79.2%为男性，25.8%有二叶式主动脉瓣。32例患者（8.10%）被分类为0期，146例（37.0%）为1期，77例（19.5%）为2期，140例（35.4%）为3期。在平均3.9±2.9年的随访期内，0期的年化死亡率为每年0.68%，1期为每年2.25%，2期为每年3.76%，3期为每年7.25%（死亡率趋势P<0.001）。在调整反流严重程度、主动脉瓣置换（AVR）和欧洲心脏手术风险评估系统II（EuroSCORE II）后，心脏重塑程度与死亡率增加独立相关（校正风险比：每增加一期为1.69[95%置信区间：1.28 - 2.23]；P<0.001）。右心重塑的患者发生事件的风险最高。
纳入CMR结果的心脏重塑分期系统在调整手术风险、AVR和反流严重程度后，为AR提供了递增的预后评估。AR中的右心重塑与最高死亡率相关。进一步的研究可以确定该分期系统是否有助于指导患者管理和干预时机。
