Peter M, Hoffmann A, Parker C, Lüscher T, Burckhardt D
Division of Cardiology, University Hospital, Basel, Switzerland.
Chest. 1993 Jun;103(6):1715-9. doi: 10.1378/chest.103.6.1715.
To determine the spontaneous progression of valvular aortic stenosis and to delineate clinical factors related to progression, a longitudinal study, including 49 patients (aged 16 to 81 years), was performed. All patients had auscultatory findings of aortic stenosis and multiple Doppler echocardiograms separated by at least 11 months. Rapid progression of aortic stenosis was defined as an increase of maximal instantaneous pressure gradient by > or = 10 mm Hg per year. During a mean follow-up period of 32 months (11 to 66 months), maximal pressure gradient rose from 38 +/- 15 to 60 +/- 20 mm Hg in the entire study population, resulting in a median increase of 7.2 mm Hg per year. In 21 patients (43 percent), an increase of > or = 10 mm Hg per year was found; in this subgroup with rapid progression, patients were older (64 vs 53 years, p < 0.01) and coronary artery disease was more prevalent (38 percent vs 7 percent, p = 0.01). We conclude that nearly half the patients with initially mild to moderate valvular aortic stenosis reveal a progression of > or = 10 mm Hg per year.
为了确定瓣膜性主动脉瓣狭窄的自然进展情况并阐明与进展相关的临床因素，我们进行了一项纵向研究，纳入了49例患者（年龄16至81岁）。所有患者均有主动脉瓣狭窄的听诊表现，且有多普勒超声心动图检查结果，检查间隔至少11个月。主动脉瓣狭窄的快速进展定义为最大瞬时压力阶差每年增加≥10 mmHg。在平均32个月（11至66个月）的随访期内，整个研究人群的最大压力阶差从38±15 mmHg升至60±20 mmHg，导致每年中位数增加7.2 mmHg。21例患者（43%）每年压力阶差增加≥10 mmHg；在这个快速进展的亚组中，患者年龄更大（64岁对53岁，p<0.01），冠状动脉疾病更为普遍（38%对7%，p = 0.01）。我们得出结论，近一半最初为轻度至中度瓣膜性主动脉瓣狭窄的患者每年压力阶差进展≥10 mmHg。
