Role of a heart valve clinic programme in the management of patients with aortic stenosis
Role of a heart valve clinic programme in the management of patients with aortic stenosis
复制标题
心脏瓣膜诊所项目在主动脉瓣狭窄患者管理中的作用
DOI：
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发表时间：
2017
影响因子：
6.2
通讯作者：
R. Rosenhek
中科院分区：
文献类型：
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作者：
R. Zilberszac;P. Lancellotti;D. Gilon;H. Gabriel;M. Schemper;G. Maurer;M. Massetti;R. Rosenhek
目的 我们试图评估心脏瓣膜诊所 (HVC) 随访计划对严重主动脉瓣狭窄 (AS) 患者的疗效。方法和结果 连续 388 名 AS 患者（年龄 71 ± 10 岁；主动脉射流速度 5.1 ± 0.6 m/s）和有主动脉瓣置换术 (AVR) 指征的患者被纳入研究。其中，290 名患者在第一次到 HVC 就诊时就出现了手术指征，98 名已参加 HVC 监测计划的无症状患者在随访期间出现了手术指征。基线时出现症状的患者（352 ± 471 天）出现症状的时间明显长于 HVC 随访患者（76 ± 75 天，P < 0.001）。尽管接受了识别并及时报告新症状的教育，HVC 项目中的 98 名患者中有 77 名等到下一次预定的咨询时才报告这些症状。初次就诊时有症状的患者中有 61% 出现严重症状（NYHA 或 CCS 等级≥III），HVC 计划中的患者中有 34% 出现严重症状（P < 0.001）。结论 AS 患者转诊和症状报告延迟以及否认症状很常见。这些发现支持风险分层的概念，以识别可能受益于择期手术的患者。结构化的 HVC 计划可以在更早且不太严重的阶段检测到症状，从而优化手术时机。
Aims We sought to assess the efficacy of a heart valve clinic (HVC) follow-up programme for patients with severe aortic stenosis (AS). Methods and results Three hundred and eighty-eight consecutive patients with AS (age 71 ± 10 years; aortic-jet velocity 5.1 ± 0.6 m/s) and an indication for aortic valve replacement (AVR) were included. Of these, 290 patients presented with an indication for surgery at their first visit at the HVC and 98 asymptomatic patients who had been enrolled in an HVC monitoring programme developed indications for surgery during follow-up. Time to symptom detection was significantly longer in patients that presented with symptoms at baseline (352 ± 471 days) than in patients followed in the HVC (76 ± 75 days, P < 0.001). Despite being educated to recognize and promptly report new symptoms, 77 of the 98 patients in the HVC programme waited until the next scheduled consultation to report them. Severe symptom onset (NYHA or CCS Class ≥III) was present in 61% of patients being symptomatic at the initial visit and in 34% of patients in the HVC programme (P < 0.001). Conclusion Delays in referral and symptom reporting as well as symptom denial are common in patients with AS. These findings support the concept of risk stratification to identify patients who may benefit from elective surgery. A structured HVC programme results in the detection of symptoms at an earlier and less severe stage and thus in an optimized timing of surgery.