Natural History of Moderate Aortic Stenosis with Preserved and Low Ejection Fraction
Natural History of Moderate Aortic Stenosis with Preserved and Low Ejection Fraction
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DOI：
10.1016/j.echo.2021.02.014
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发表时间：
2021-07-02
影响因子：
6.5
通讯作者：
Topilsky, Yan
中科院分区：
文献类型：
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作者：
Mann, Tomer D.;Loewenstein, Itamar;Topilsky, Yan
背景：关于中度主动脉瓣狭窄（AS）患者的自然病史的数据不足。本研究的目的是评估中度AS对一般人群以及中度AS和射血分数（EF）降低患者亚组和中度AS和低主动脉瓣压差患者亚组死亡率的影响。该研究的设计目的不是为了解决该人群治疗的适用性。方法：比较中度AS患者和无AS的倾向匹配队列（1：3比例）患者的结局。主要结局是随访结束时的生存率。结果：在2011年至2016年间接受超声心动图评估的约40，000名患者中，952名患有中度AS。整个队列的中位随访时间为181周（四分位距，179- 182周），倾向匹配组为174周（四分位距，169-179周）。倾向匹配成功地平衡了大多数先前存在的临床差异。中度AS患者在倾向匹配前死亡率增加，倾向匹配后死亡率持续增加（中位生存期4.1年vs 5.2年，P = 0.008）。1年、2年、3年和5年的生存率和相应的标准误分别为80 +/- 1%和82 +/-0.7%，70 +/- 1.5%和74 +/-0.8%，62 +/- 1.7%和66 +/-0.9%，47 +/- 2.4%和52 +/-1.3%。在中度AS和射血分数降低（P = 0.028）和中度AS和低主动脉瓣压差（P = 0.039）的亚组分析中观察到类似的生存差异。结论：中度AS与死亡率增加相关。在射血分数降低或主动脉瓣压差降低的患者亚组中也观察到死亡率增加。（J Am Soc Echocardiogr 2021;34：735-43.）结果：在2011年至2016年间接受超声心动图评估的约40，000名患者中，952名患有中度AS。整个队列的中位随访时间为181周（四分位距，179- 182周），倾向匹配组的中位随访时间为174周（四分位距，169-179周）。倾向匹配成功地平衡了大多数先前存在的临床差异。中度AS患者在倾向匹配前死亡率增加，倾向匹配后死亡率持续增加（中位生存期4.1年vs 5.2年，P = 0.008）。1年、2年、3年和5年的生存率和相应的标准误分别为80 +/- 1%和82 +/-0.7%，70 +/- 1.5%和74 +/-0.8%，62 +/- 1.7%和66 +/-0.9%，47 +/- 2.4%和52 +/-1.3%。在中度AS和射血分数降低（P = 0.028）和中度AS和射血分数降低（P = 0.028）的亚组分析中，
Background: There is a shortage of data concerning the natural history of patients with moderate aortic stenosis (AS). The aim of this study was to assess the effect of moderate AS on mortality in the general population and in the subgroups of patients with moderate AS and reduced ejection fractions (EF) and patients with moderate AS and low aortic valve gradients. The study was not designed to address the applicability of treatment in this population. Methods: Outcomes were compared between patients with moderate AS and a propensity-matched cohort (1:3 ratio) without AS. The primary outcome was survival until end of follow-up. Results: Among approximately 40,000 patients who underwent echocardiographic evaluations between 2011 and 2016, 952 had moderate AS. Median follow-up duration was 181 weeks (interquartile range, 179- 182 weeks) for the entire cohort and 174 weeks (interquartile range, 169-179 weeks) for the propensity matched groups. Propensity matching successfully balanced most preexisting clinical differences. Increased mortality was observed in the group of patients with moderate AS before propensity matching and persisted following propensity matching (median survival 4.1 vs 5.2 years, P = .008). Survival rates and corresponding standard errors at 1, 2, 3, and 5 years were 80 +/- 1% versus 82 +/- 0.7%, 70 +/- 1.5% versus 74 +/- 0.8%, 62 +/- 1.7% versus 66 +/- 0.9%, and 47 +/- 2.4% versus 52 +/- 1.3%, respectively. A survival difference was similarly observed for the subgroup analyses of moderate AS and reduced ejection fraction (P = .028) and moderate AS and low aortic valve gradients (P = .039). Conclusions: Moderate AS is associated with increased mortality. The increased mortality was also observed in the subgroups of patients with either reduced ejection fraction or low aortic valve gradients. (J Am Soc Echocardiogr 2021;34:735-43.)Results: Among approximately 40,000 patients who underwent echocardiographic evaluations between 2011 and 2016, 952 had moderate AS. Median follow-up duration was 181 weeks (interquartile range, 179- 182 weeks) for the entire cohort and 174 weeks (interquartile range, 169-179 weeks) for the propensitymatched groups. Propensity matching successfully balanced most preexisting clinical differences. Increased mortality was observed in the group of patients with moderate AS before propensity matching and persisted following propensity matching (median survival 4.1 vs 5.2 years, P = .008). Survival rates and corresponding standard errors at 1, 2, 3, and 5 years were 80 +/- 1% versus 82 +/- 0.7%, 70 +/- 1.5% versus 74 +/- 0.8%, 62 +/- 1.7% versus 66 +/- 0.9%, and 47 +/- 2.4% versus 52 +/- 1.3%, respectively. A survival difference was similarly observed for the subgroup analyses of moderate AS and reduced ejection fraction (P = .028) and mod