Staging classification of aortic stenosis based on the extent of cardiac damage
Staging classification of aortic stenosis based on the extent of cardiac damage
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DOI：
10.1093/eurheartj/ehx381
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发表时间：
2017-12-01
影响因子：
39.3
通讯作者：
Leon, Martin B.
中科院分区：
文献类型：
--
作者：
Genereux, Philippe;Pibarot, Philippe;Leon, Martin B.
目的 对于主动脉瓣狭窄 (AS) 患者，主动脉瓣置换术 (AVR) 的风险分层主要依赖于瓣膜相关因素、症状和合并症。我们试图评估新定义的分期分类对预后的影响，该分期描述了接受 AVR 的严重 AS 患者的瓣外（主动脉瓣外）心脏损伤的程度。方法和结果 PARTNER 2 试验中的严重 AS 患者根据 AVR 前超声心动图检测到的心脏损伤是否存在进行汇总和分类：无瓣外心脏损伤（0 期）、左心室损伤（1 期）、左心房或二尖瓣损伤（第 2 阶段）、肺血管系统或三尖瓣损伤（第 3 阶段）或右心室损伤（第 4 阶段）。使用 KaplanMeier 技术比较一年结果，并使用多变量 Cox 比例风险模型来确定一年死亡率预测因子。在 1661 名具有足够超声心动图数据以允许分期的患者中，47 名 (2.8%) 患者被分类为 0 期，212 名 (12.8%) 为 1 期，844 名 (50.8%) 为 2 期，413 名 (24.9%) 为 3 期，145 名 (8.7%) 为 4 期。0 期的一年死亡率为 4.4%，第一阶段为 9.2%，第二阶段为 14.4%，第三阶段为 21.3%，第四阶段为 24.5%（P 趋势 < 0.0001）。心脏损伤的程度与 AVR 后死亡率增加独立相关（每个分期增量 HR 1.46，95% 置信区间 1.27-1.67，P < 0.0001） 结论 这一新描述的分期分类客观地描述了与 AS 相关的心脏损伤程度，对 AVR 后的临床结果具有重要的预后意义。
Aims In patients with aortic stenosis (AS), risk stratification for aortic valve replacement (AVR) relies mainly on valverelated factors, symptoms and co-morbidities. We sought to evaluate the prognostic impact of a newly-defined staging classification characterizing the extent of extravalvular (extra-aortic valve) cardiac damage among patients with severe AS undergoing AVRMethods and results Patients with severe AS from the PARTNER 2 trials were pooled and classified according to the presence or absence of cardiac damage as detected by echocardiography prior to AVR: no extravalvular cardiac damage (Stage 0), left ventricular damage (Stage 1), left atrial or mitral valve damage (Stage 2), pulmonary vasculature or tricuspid valve damage (Stage 3), or right ventricular damage (Stage 4). One-year outcomes were compared using KaplanMeier techniques and multivariable Cox proportional hazards models were used to identify 1-year predictors of mortality. In 1661 patients with sufficient echocardiographic data to allow staging, 47 (2.8%) patients were classified as Stage 0, 212 (12.8%) as Stage 1, 844 (50.8%) as Stage 2, 413 (24.9%) as Stage 3, and 145 (8.7%) as Stage 4. Oneyear mortality was 4.4% in Stage 0, 9.2% in Stage 1, 14.4% in Stage 2, 21.3% in Stage 3, and 24.5% in Stage 4 (P-trend < 0.0001). The extent of cardiac damage was independently associated with increased mortality after AVR (HR 1.46 per each increment in stage, 95% confidence interval 1.27-1.67, P < 0.0001)Conclusion This newly described staging classification objectively characterizes the extent of cardiac damage associated with AS and has important prognostic implications for clinical outcomes after AVR.