The evolving epidemiology of valvular aortic stenosis. The Tromso Study
The evolving epidemiology of valvular aortic stenosis. The Tromso Study
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DOI：
10.1136/heartjnl-2012-302265
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发表时间：
2013-03-01
期刊：
影响因子：
5.7
通讯作者：
Rasmussen, Knut
中科院分区：
文献类型：
--
作者：
Eveborn, Gry Wisthus;Schirmer, Henrik;Rasmussen, Knut
目的评估退行性主动脉瓣狭窄（AS）的患病率、发病率、预后和进展情况。设置Tromso研究和北挪威大学医院。设计基于人群的前瞻性研究。人群在14年的时间跨度内，我们对最初3273名参与者进行了三次重复超声心动图检查（1994年、2001年和2008年）。从唯一的医院为这一人群提供服务的数据包括在内。患病率随着年龄的增长而不断增加，50-59岁队列的平均值为0.2%，60-69岁队列为1.3%，70-79岁队列为3.9%，80-89岁队列为9.8%。研究中的发病率为4.9%/年。平均跨瓣压差的平均年增量为3.2 mm Hg。轻度AS的增加低于更严重的疾病，揭示了梯度的非线性发展，但有很大的个体差异。无症状AS组（HR=1.28）死亡率没有显着增加，也没有在那些谁接受主动脉瓣置换术（n=34，HR=0.93），与一般population.Conclusion相比，这是第一个研究记录AS的发病率和预后在一般人群中手术作为一种治疗选择。它揭示了随着疾病的进展，主动脉平均跨瓣压差的加速进展。AS的预后似乎与无症状阶段和成功手术后的正常人群相当，表明该患者组的随访和手术时机已经足够。
Objective To assess prevalence, incidence, prognosis and progression of degenerative valvular aortic stenosis (AS).Setting The Tromso Study and the University Hospital of North Norway.Design Population based prospective study.Population Over a 14 year span we performed three repeated echocardiographic examinations (1994, 2001 and 2008) of a random sample of initially 3273 participants. Data from the only hospital serving this population were included.Results There were 164 subjects with AS. Prevalence consistently increased with age, average values being 0.2% in the 50-59 year cohort, 1.3% in the 60-69 year cohort, 3.9% in the 70-79 year cohort and 9.8% in the 80-89 year cohort. The incidence rate in the study was 4.9%/year. The mean annual increase in mean transvalvular pressure gradient was 3.2 mm Hg. The increase was lower in mild AS than in more severe disease, disclosing a non-linear development of the gradient, but with large individual variations. Mortality was not significantly increased in the asymptomatic AS-group (HR=1.28), nor in those who received aortic valve replacement (n=34, HR=0.93), compared with the general population.Conclusion This is the first study to document the incidence and prognosis of AS in a general population with surgery as a treatment option. It reveals an accelerated progression of the aortic mean gradient as the disease advances. The prognosis of AS seems to be comparable with the normal population in the asymptomatic stage and after successful surgery, indicating that the follow-up and timing of surgery has been adequate for this patient group.