THE NATURAL HISTORY OF ASYMPTOMATIC PATIENTS WITH AORTIC REGURGITATION

在以前的报告中，我们证明了无症状患者 慢性重度主动脉瓣返流（AR）和正常左 心室（LV）收缩功能预后良好， 每年少于4%的患者需要主动脉瓣置换术 因为出现了症状左心室功能障碍或两者都有 此外，本发明还提供了一种方法， 基线超声心动图和放射性核素血管造影 测量结果有助于确定高风险亚组。 在该报告中，我们纳入了79例平均随访时间为 4年期间，12例患者需要手术。 我们将该系列扩展到104例患者， 8年（范围2-15年），25起事件（2例患者死亡 23例手术治疗）。 11年时，58%的患者 无症状，左心室功能正常， 低于4%/年。 描述LV功能的许多变量 与结果相关，但通过多变量生命表分析， 仅年龄、初始研究时的超声心动图LV收缩期尺寸， 左室收缩期内径和放射性核素的变化率 在系列研究中，静息时的血管造影射血分数 与结果独立相关。 因此，在 按基线确定为低风险或高风险的慢性AR患者 测量，根据风险进一步分层可能是 根据LV收缩功能的连续变化进行 随着时间的推移 此外，左心室射血分数对 运动对预测变应性鼻炎的预后没有帮助， 静息左心室功能。

In a previous report, we demonstrated that asymptomatic patients with chronic severe aortic regurgitation (AR) and normal left ventricular (LV) systolic function have an excellent prognosis, with less than 4% per year requiring aortic valve replacement because symptoms, LV dysfunction, or both develop. In addition, baseline echocardiographic and radionuclide angiographic measurements were useful in identifying a higher risk subgroup. In that report, we included 79 patients with a mean follow-up period of 4 years, during which 12 patients required operation. We have extended this series to 104 patients followed over a mean 8 year period (range 2-15 years), with 25 events (2 patients died suddenly and 23 underwent operation). At 11 years, 58% of patients remained asymptomatic with normal LV function, an attrition rate less than 4%/year. Many variables describing LV function were associated with outcome, but by multivariate life-table analysis, only age, echocardiographic LV systolic dimension at initial study, and the rate of change in LV systolic dimension and in radionuclide angiographic ejection fraction at rest during serial studies were independently associated with outcome. Thus, within subgroups of patients with chronic AR identified at low or high risk by baseline measurements, further stratification according to risk may be performed on the basis of serial changes in LV systolic function with time. In addition, the LV ejection fraction response to exercise is not helpful to predicting outcome in AR, once age and resting LV function are accounted for.