Aortic stenosis: insights on pathogenesis and clinical implications.
Aortic stenosis: insights on pathogenesis and clinical implications.
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DOI：
10.11909/j.issn.1671-5411.2016.06.001
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发表时间：
2016-09
期刊：
影响因子：
--
通讯作者：
Corrado E
中科院分区：
文献类型：
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作者：
Carità P;Coppola G;Novo G;Caccamo G;Guglielmo M;Balasus F;Novo S;Castrovinci S;Moscarelli M;Fattouch K;Corrado E
主动脉瓣狭窄（Aortic stenosis， AS）是西方人群中一种常见的瓣膜性心脏病，在75岁以上的成年人中估计总患病率为3%。了解其病理生物学过程是当务之急。在老年患者中，AS通常包括三叶瓣膜，被称为退行性钙化过程。科学证据表明，在退行性AS的起始阶段，涉及一种活跃的“动脉粥样硬化样”发病机制。相反，这种进展可能是由不同的力量驱动的（如机械应力、遗传因素以及炎症和钙化之间的相互作用）。提高认识提出了潜在的新的治疗靶点，以预防和抑制疾病的发展和进展。此外，在临床实践中，AS患者的管理意味着评估广泛的动脉粥样硬化表现（即冠状动脉和颈动脉），甚至出于预后原因。在对老年患者进行咨询时，风险分层应针对个体脆弱性，而不是一般风险评分。在这些方面，应该仔细调查合并症，特别是那些与全球动脉粥样硬化负担相关的合并症，以确定侵入性治疗策略的风险/收益比。我们提出了一个详细的概述，见解的发病机制与可能的实际意义。
Aortic stenosis (AS) is a common valvular heart disease in the Western populations, with an estimated overall prevalence of 3% in adults over 75 years. To understand its patho-biological processes represents a priority. In elderly patients, AS usually involves trileaflet valves and is referred to as degenerative calcific processes. Scientific evidence suggests the involvement of an active “atherosclerosis-like” pathogenesis in the initiation phase of degenerative AS. To the contrary, the progression could be driven by different forces (such as mechanical stress, genetic factors and interaction between inflammation and calcification). The improved understanding presents potentially new therapeutic targets for preventing and inhibiting the development and progression of the disease. Furthermore, in clinical practice the management of AS patients implies the evaluation of generalized atherosclerotic manifestations (i.e., in the coronary and carotid arteries) even for prognostic reasons. In counselling elderly patients, the risk stratification should address individual frailty beyond the generic risk scores. In these regard, the co-morbidities, and in particular those linked to the global atherosclerotic burden, should be carefully investigated in order to define the risk/benefit ratio for invasive treatment strategies. We present a detailed overview of insights in pathogenesis of AS with possible practical implications.