Comorbidities and Symptom Status in Moderate and Severe Aortic Stenosis
Comorbidities and Symptom Status in Moderate and Severe Aortic Stenosis
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中度和重度主动脉瓣狭窄的合并症和症状状态
DOI：
10.1016/j.jacadv.2023.100356
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
G. Strange
中科院分区：
文献类型：
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作者：
D. Playford;N. Schwarz;Emon Kalyan Chowdhury;A. Williamson;M. Duong;L. Kearney;S. Stewart;G. Strange
背景：严重主动脉瓣狭窄（AS）的相关症状被用来指导治疗。目的本研究的目的是检查中度和重度AS的症状模式、合并症和心脏损害。方法从330,940例年龄在bb0 ~ 18岁的患者中选取846,198份超声心动图调查，进行最近的超声心动图检查，中度或重度AS（平均梯度20.0 ~ 39.9 mm Hg，主动脉瓣峰值梯度3.0 ~ 3.9 m/s，主动脉瓣面积>1.0 cm2；或40.0 mm Hg,≥4.0 m/s或≤1.0 cm2），并咨询心脏病专家。自然语言处理应用于字母提取合并症，呼吸困难，胸痛和晕厥。排除有主动脉瓣置换术史的患者。结果中度AS 2213例（总体占0.7%，女性占32.8%），重度AS 3416例（女性占1.0%,47.3%）。合并症较为常见，包括高血压（中度AS占56.6%，重度AS占53.1%，P= 0.01）、冠心病（分别占46.0%和46.8%，P= 0.58）和房颤（分别占29.6%和34.8%，P< 0.001）。中度AS （n = 915, 41.3%）和重度AS （n = 1630, 47.7%）的症状也很常见（P< 0.001）。有症状的患者比无症状的患者更容易出现合并症（P< 0.001）。严重AS患者更容易出现呼吸困难，而中度和重度AS患者心绞痛和晕厥相似。在多变量分析中，只有呼吸困难与严重（相对于中度）AS相关（OR: 1.73, 95% CI: 1.41-2.13，P< 0.001）。在调整和未调整的模型中，心脏损伤程度与任何症状的存在无关，但与AS的严重程度相关。结论呼吸困难在中重度AS患者中都很常见，且与合并症有关，与心脏损害程度无关。AS症状导向的管理决策可能需要修订。
BackgroundSymptoms associated with severe aortic stenosis (AS) are used to guide management.ObjectivesThe purpose of this study was to examine the pattern of symptoms, comorbidities, and cardiac damage in moderate and severe AS.MethodsA total of 846,198 echocardiographic investigations from 330,940 individuals aged >18 years were selected for the most recent echocardiogram, moderate or severe AS (mean gradient 20.0-39.9 mm Hg, aortic valve peak gradient 3.0-3.9 m/s and aortic valve area >1.0 cm2; or40.0 mm Hg, ≥4.0 m/s or ≤1.0 cm2, respectively), and a cardiologist consultation. Natural Language Processing was applied to letters to extract comorbidities, dyspnea, chest pain, and syncope. Patients with prior aortic valve replacement were excluded.Results2,213 patients (0.7% overall, 32.8% females) had moderate and 3,416 (1.0%, 47.3% females) had severe AS. Comorbidities were common, including hypertension, (56.6% moderate AS, 53.1% severe AS,P= 0.01), coronary disease (46.0% and 46.8%, respectively,P= 0.58) and atrial fibrillation (29.6% and 34.8%, respectively,P< 0.001). Symptoms were also common inbothmoderate (n = 915, 41.3%) and severe (n = 1,630, 47.7%) AS (P< 0.001). Comorbidities were more likely in symptomatic vs asymptomatic patients (P< 0.001). Dyspnea was more likely in severe AS, whereas angina and syncope were similar in moderate vs severe AS. In multivariable analysis, only dyspnea was associated with severe (vs moderate) AS (OR: 1.73, 95% CI: 1.41-2.13,P< 0.001). In both adjusted and unadjusted models, the degree of cardiac damage did not relate to presence of any symptoms but was associated with AS severity.ConclusionsDyspnea is common inbothmoderate and severe AS, is associated with comorbidities and is not related to the degree of cardiac damage. Symptom-guided management decisions in AS may need revision.