Prognostic Impact of Left Ventricular Ejection Fraction in Patients With Severe Aortic Stenosis
Prognostic Impact of Left Ventricular Ejection Fraction in Patients With Severe Aortic Stenosis
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DOI：
10.1016/j.jcin.2017.08.036
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发表时间：
2018-01-22
影响因子：
11.3
通讯作者：
Kimura, Takeshi
中科院分区：
文献类型：
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作者：
Taniguchi, Tomohiko;Morimoto, Takeshi;Kimura, Takeshi
目的：本研究的目的是评估左心室射血分数 (LVEF) 对严重主动脉瓣狭窄 (AS) 患者的预后影响。背景：LVEF 对严重主动脉瓣狭窄 (AS) 的预后影响仍存在争议。方法：在 CURRENT AS（严重主动脉瓣狭窄患者手术和药物治疗后的当代结果）中连续纳入 3,815 名严重 AS 患者。在排除 21 名没有 LVEF 数据的患者后，目前的研究人群由 3,794 名患者组成。根据超声心动图指数 LVEF 将患者分为 4 组（= 70%；保守策略：n = 388、n = 390、n = 1,025 和 n = 800；初始主动脉瓣置换策略：n = 206、n = 170、n = 375 和 n = 440）。超声心动图数据是现场报告的，并且没有超声心动图核心实验室。 结果：在保守组中，LVEF = 70% 的患者主要结局指标（主动脉瓣相关死亡或心力衰竭住院治疗的综合结果）的 5 年累积发生率显着较高（分别为 72.3%、58.4%、38.7% 和 35.0%，p < 0.001），而在保守组中，在初始主动脉瓣置换组中，低 LVEF 的负面影响明显减弱（分别为 20.2%、20.3%、17.7% 和 12.4%，p = 0.03）。调整混杂因素后，保守组的 LVEF = 70%（参考）。在初始主动脉瓣置换术组中，4 个 LVEF 组的主要结局指标的调整风险没有显着差异。 结论：本研究表明，当 LVEF 低于正常值时，严重 AS 患者的生存率会受到损害。
OBJECTIVES: The aim of this study was to evaluate the prognostic impact of left ventricular ejection fraction (LVEF) in patients with severe aortic stenosis (AS).BACKGROUND: The prognostic impact of LVEF in severe AS remains controversial.METHODS: Among 3,815 consecutive patients with severe AS enrolled in the CURRENT AS (Contemporary Outcomes After Surgery and Medical Treatment in Patients With Severe Aortic Stenosis) registry, the present study population consisted of 3,794 patients after excluding 21 patients without LVEF data. Patients were divided into 4 groups according to LVEF at index echocardiography (= 70%; conservative strategy: n = 388, n = 390, n = 1,025, and n = 800; initial aortic valve replacement strategy: n = 206, n = 170, n = 375, and n = 440). Echocardiographic data were site reported, and there was no echocardiography core laboratory.RESULTS: In the conservative group, the cumulative 5-year incidence of the primary outcome measure (a composite of aortic valve-related death or heart failure hospitalization) was significantly higher in patients with LVEFs = 70% (72.3%, 58.4%, 38.7%, and 35.0%, respectively, p < 0.001), whereas in the initial aortic valve replacement group, the negative effect of low LVEF was markedly attenuated (20.2%, 20.3%, 17.7%, and 12.4%, respectively, p = 0.03). After adjusting for confounders, LVEF = 70% (reference) in the conservative group. In the initial aortic valve replacement group, the adjusted risk for the primary outcome measure was not significantly different across the 4 LVEF groups.CONCLUSIONS: This study demonstrates that survival in patients with severe AS is impaired when LVEF is