Natural History of Very Severe Aortic Stenosis
Natural History of Very Severe Aortic Stenosis
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DOI：
10.1161/circulationaha.109.894170
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发表时间：
2010-01-05
期刊：
影响因子：
37.8
通讯作者：
Maurer, Gerald
中科院分区：
文献类型：
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作者：
Rosenhek, Raphael;Zilberszac, Robert;Maurer, Gerald
背景：我们试图评估无症状的非常严重的主动脉狭窄患者的预后。方法和结果：我们前瞻性随访116例连续无症状患者（57例女性，年龄67+/-16岁），伴有非常严重的孤立性主动脉狭窄，定义为峰值主动脉射流速度(AV-Vel) >= 5.0 m/s（平均AV-Vel 5.37+/-0.35 m/s；瓣膜面积0.63+/-0.12 cm(2)）。在中位随访41个月（四分位数范围26至63个月）期间，发生了96起事件（主动脉瓣置换术指征，90例；心源性死亡，6例）。1年、2年、3年、4年和6年的无事件生存率分别为64%、36%、25%、12%和3%。AV-Vel而非主动脉瓣面积独立影响无事件生存。AV-Vel值为5.5 m/s的患者在1年、2年、3年和4年的无事件生存率分别为44%、25%、11%和4%，而AV-Vel值为5.0至5.5 m/s （P= 5.5 m/s）的患者发生严重症状的可能性（52%）高于AV-Vel值为5.0至5.5 m/s的患者（27%，P=0.03）。结论：尽管无症状，但非常严重的主动脉瓣狭窄患者预后差，发生率高，功能迅速恶化的风险大。因此，这些患者应考虑早期择期瓣膜置换术。（循环。2010;121:151-156。）
Background-We sought to assess the outcome of asymptomatic patients with very severe aortic stenosis.Methods and Results-We prospectively followed 116 consecutive asymptomatic patients (57 women; age, 67+/-16 years) with very severe isolated aortic stenosis defined by a peak aortic jet velocity (AV-Vel) >= 5.0 m/s (average AV-Vel, 5.37+/-0.35 m/s; valve area, 0.63+/-0.12 cm(2)). During a median follow-up of 41 months (interquartile range, 26 to 63 months), 96 events occurred (indication for aortic valve replacement, 90; cardiac deaths, 6). Event-free survival was 64%, 36%, 25%, 12%, and 3% at 1, 2, 3, 4, and 6 years, respectively. AV-Vel but not aortic valve area was shown to independently affect event-free survival. Patients with an AV-Vel >= 5.5 m/s had an event-free survival of 44%, 25%, 11%, and 4% at 1, 2, 3, and 4 years, respectively, compared with 76%, 43%, 33%, and 17% for patients with an AV-Vel between 5.0 and 5.5 m/s (P= 5.5 m/s had a higher likelihood (52%) of severe symptom onset (New York Heart Association or Canadian Cardiovascular Society class >II) than those with an AV-Vel between 5.0 and 5.5 m/s (27%; P=0.03).Conclusions-Despite being asymptomatic, patients with very severe aortic stenosis have a poor prognosis with a high event rate and a risk of rapid functional deterioration. Early elective valve replacement surgery should therefore be considered in these patients. (Circulation. 2010; 121: 151-156.)