Value of Transvalvular Flow Rate during Exercise in Asymptomatic Patients with Aortic Stenosis
Value of Transvalvular Flow Rate during Exercise in Asymptomatic Patients with Aortic Stenosis
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DOI：
10.1016/j.echo.2019.11.007
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发表时间：
2020-04-01
影响因子：
6.5
通讯作者：
Akashi, Yoshihiro J.
中科院分区：
文献类型：
--
作者：
Hirasawa, Kensuke;Izumo, Masaki;Akashi, Yoshihiro J.
背景：无症状主动脉瓣狭窄（AS）的最佳治疗方法仍存在争议。虽然运动应激超声心动图（ESE）已被应用于非缺血性心脏病，但对无症状AS的预后价值的证据有限。本研究旨在探讨ESE在无症状AS患者中的价值。方法：本回顾性观察性研究纳入了连续无症状的至少中度AS患者（平均压力梯度>= 20 mm Hg或主动脉瓣面积< 1.5 cm(2)），并保留左心室射血分数（>= 50%），接受ESE治疗。其中，10名无症状转介主动脉瓣置换术的患者被排除在外。最终纳入99例保守治疗患者（73 6 13岁，男性占54%）。随访所有患者的as相关事件。结果：平均随访14 ~ 11个月，23例患者发生as相关事件。尽管有不良事件的患者和没有不良事件的患者在运动时的平均压力梯度方面没有差异，但有不良事件的患者运动时的经瓣血流速率（Ex-FR）较低（236 +/- 655 vs 274 +/- 664 mL/sec， P= 0.01）。多因素Cox回归分析显示Ex-FR (
Background: The optimal management of asymptomatic aortic stenosis (AS) remains controversial. Although exercise stress echocardiography (ESE) has been applied to nonischemic heart disease, the evidence of the prognostic value for asymptomatic AS has been limited. This study aimed to investigate the value of ESE in patients with asymptomatic AS.Methods: This retrospective observational study included consecutive asymptomatic patients with at least moderate AS (mean pressure gradient >= 20 mm Hg or aortic valve area < 1.5 cm(2)) and preserved left ventricular ejection fraction (>= 50%) who underwent ESE. Of these, 10 patients who were referred for aortic valve replacement without symptoms were excluded. A final 99 conservatively managed patients (73 6 13 years; 54% male) were enrolled in this study. All patients were followed for AS-related events.Results: During the mean follow-up period of 14 6 11 months, 23 patients underwent from AS-related events. Although no differences were found between the patients with and without adverse events in terms of mean pressure gradient during exercise, the transvalvular flow rate during exercise (Ex-FR) was lower in the patients who experienced adverse events (236 +/- 655 vs 274 +/- 664 mL/sec, P=.01). Multivariate Cox regression analysis showed a decrease in Ex-FR (