Adverse outcome in aortic sclerosis is associated with coronary artery disease and inflammation
Adverse outcome in aortic sclerosis is associated with coronary artery disease and inflammation
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DOI：
10.1016/j.jacc.2003.08.036
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发表时间：
2004-01-21
影响因子：
24
通讯作者：
O'Neill, WW
中科院分区：
文献类型：
--
作者：
Chandra, HR;Goldstein, JA;O'Neill, WW
本研究旨在评估主动脉硬化、炎症血清学标志物和不良心血管结局之间的关系。然而，这种非阻塞性瓣膜病变的机制，赋予过多的心血管风险尚未划定。方法在425例（平均年龄68 +/-15岁，54%的男性）提出的急诊室胸痛，我们研究了主动脉硬化，冠状动脉疾病的存在和急性，炎症的血清学标志物，心血管疾病的结果之间的关系。患者接受超声心动图和血清学检测，包括C反应蛋白（CRP）。主动脉瓣硬化的程度进行了分级，心血管结局，包括心脏性死亡和非致命性心肌梗死（MI）进行了分析超过一年。结果主动脉硬化被确定在203例（49%），而212（51%）有正常的主动脉瓣。在1年的单变量分析中，主动脉硬化患者的心血管事件发生率较高（16.8% vs. 7.1%，p = 0.002），无事件生存率较差（瓣膜正常= 93%，轻度主动脉硬化= 85%，中度至重度主动脉硬化= 77%，p = 0.002）。然而，通过多变量分析，主动脉硬化与不良心血管结局无关;一年内心源性死亡或心肌梗死的唯一独立预测因素是冠状动脉疾病（风险比[HR] 3.23，p = 0.003），首次入院时MI（HR 2.77，p = 0.008），CRP的上升三分位数（HR 2.2，p = 0.001），充血性心力衰竭（HR 2.15，p = 0.02）和年龄结论：主动脉硬化患者不良心血管事件的发生率增加与冠状动脉疾病和炎症有关，而不是心脏瓣膜病本身的影响。(C)2004年，美国心脏病学会基金会。
OBJECTIVES The present study was designed to evaluate the relationship between the presence of aortic sclerosis, serologic markers of inflammation, and adverse cardiovascular outcomes.BACKGROUND Aortic sclerosis is associated with adverse cardiovascular outcomes. However, the mechanism by which such nonobstructive valve lesions impart excess cardiovascular risk has not been delineated.METHODS In 425 patients (mean age 68 +/- 15 years, 54% men) presenting to the emergency room with chest pain, we studied the relationship among aortic sclerosis, the presence and acuity of coronary artery disease, serologic markers of inflammation, and cardiovascular outcomes. Patients underwent echocardiography and serologic testing including C-reactive protein (CRP). Aortic valves were graded for the degree of sclerosis, and cardiovascular outcomes including cardiac death and nonfatal myocardial infarction (MI) were analyzed over one year.RESULTS Aortic sclerosis was identified in 203 patients (49%), whereas 212 (51%) had normal aortic valves. On univariate analysis at one year, patients with aortic sclerosis had a higher incidence of cardiovascular events (16.8% vs. 7.1%, p = 0.002) and worse event-free survival (normal valves = 93%, mild aortic sclerosis = 85%, and moderate to severe aortic sclerosis = 77%, p = 0.002). However, by multivariable analysis aortic sclerosis was not independently associated with adverse cardiovascular outcomes; the only independent predictors of cardiac death or MI at one year were coronary artery disease (hazard ratio [HR] 3.23, p = 0.003), MI at index admission (HR 2.77, p = 0.008), ascending tertiles of CRP (HR 2.2, p = 0.001), congestive heart failure (HR 2.15, p = 0.02) and age (HR 1.03, p = 0.04).CONCLUSIONS The increased incidence of adverse cardiovascular events in patients with aortic sclerosis is associated with coronary artery disease and inflammation, not a result of the effects of valvular heart disease per se. (C) 2004 by the American College of Cardiology Foundation.