Outcome of 622 adults with asymptomatic, hemodynamically significant aortic stenosis during prolonged follow-up
Outcome of 622 adults with asymptomatic, hemodynamically significant aortic stenosis during prolonged follow-up
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DOI：
10.1161/circulationaha.104.495903
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发表时间：
2005-06-21
期刊：
影响因子：
37.8
通讯作者：
Tajik, AJ
中科院分区：
文献类型：
--
作者：
Pellikka, PA;Sarano, ME;Tajik, AJ
背景-本研究评估了一个大的，无症状的人群的长期结果与血流动力学显着的主动脉瓣狭窄（AS）。无症状AS和多普勒超声心动图显示的收缩期峰值速度>= 4 m/ s，在初始评估和随访时未接受手术（5.4 +/- 4.0年）。平均年龄（+/- SD）为72 +/- 11岁;有384例（62%）男性。在1年、2年和5年时，未手术时保持无心脏症状的概率分别为82%、67%和33%。主动脉瓣面积和左心室肥厚预测症状的发展。在随访期间，352例（57%）患者转诊接受主动脉瓣手术，265例（43%）患者死亡，包括117例（19%）心源性死亡。1年、2年和5年免于手术或心源性死亡的概率分别为80%、63%和25%。全因死亡率的多变量预测因子为年龄（风险比[ HR]，1.05; P < 0.0001）、慢性肾功能衰竭（HR，2.41; P = 0.004）、不活动（HR，2.00; P = 0.001）和主动脉瓣速度（HR，1.46; P = 0.03）。270例未手术患者中，11例（4.1%）发生了无既往症状的猝死。峰值流速>= 4.5 m/ s的患者出现症状（相对危险度为1.34）或手术或心源性死亡（相对危险度为1.48）的可能性更高。猝死发生率约为1%/年。年龄、慢性肾功能衰竭、不活动和主动脉瓣速度是全因死亡率的独立预测因素.
Background - This study assessed the long- term outcome of a large, asymptomatic population with hemodynamically significant aortic stenosis ( AS).Methods and Results - We identified 622 patients with isolated, asymptomatic AS and peak systolic velocity >= 4 m/ s by Doppler echocardiography who did not undergo surgery at the initial evaluation and obtained follow- up ( 5.4 +/- 4.0 years) in all. Mean age ( +/- SD) was 72 +/- 11 years; there were 384 ( 62%) men. The probability of remaining free of cardiac symptoms while unoperated was 82%, 67%, and 33% at 1, 2, and 5 years, respectively. Aortic valve area and left ventricular hypertrophy predicted symptom development. During follow- up, 352 ( 57%) patients were referred for aortic valve surgery and 265 ( 43%) patients died, including cardiac death in 117 ( 19%). The 1-, 2-, and 5- year probabilities of remaining free of surgery or cardiac death were 80%, 63%, and 25%, respectively. Multivariate predictors of all- cause mortality were age ( hazard ratio [ HR], 1.05; P < 0.0001), chronic renal failure ( HR, 2.41; P = 0.004), inactivity ( HR, 2.00; P = 0.001), and aortic valve velocity ( HR, 1.46; P = 0.03). Sudden death without preceding symptoms occurred in 11 ( 4.1%) of 270 unoperated patients. Patients with peak velocity >= 4.5 m/ s had a higher likelihood of developing symptoms ( relative risk, 1.34) or having surgery or cardiac death ( relative risk, 1.48).Conclusions - Most patients with asymptomatic, hemodynamically significant AS will develop symptoms within 5 years. Sudden death occurs in approximate to 1%/ y. Age, chronic renal failure, inactivity, and aortic valve velocity are independently predictive of all- cause mortality.