JAHA:低梯度重度主动脉瓣狭窄的患病率和患者结局

2021-11-02 MedSci原创 MedSci原创

在常规临床诊疗实践中,大约一半伴有重度AS超声心动图特征的患者具有低梯度血流动力学,这与长期死亡率相关,并与高梯度重度AS相当或更差。最差的患者存活率与典型的LFLG严重AS相关。

在常规心脏病临床诊疗实践中,不同亚型的严重低梯度主动脉瓣狭窄(AS)患病率和患者结局尚未得到很好的归纳。

近日,血管疾病领域权威杂志JAHA上发表了一篇研究文章,该研究的数据来自澳大利亚国家超声心动图数据库。

在2000年至2019年间具有天然主动脉瓣剖面的192060名成人(年龄为62.8±17.8[平均±标准差]岁)中,12013名(6.3%)患有严重的AS。其中,5601名患者(47%)为高梯度AS,6412名患者(53%)为低梯度重度AS。2741名(42.7%)低梯度AS患者记录了每搏输出量指数;1750名患者(64%)伴有低流量、低梯度(LFLG);991例患者血流正常,低梯度。在LFLG患者中,1570名(89.7%)患者记录了左心室射血分数;959名(61%)患者伴有相互矛盾的LFLG(左心室射血分数正常),611名(39%)患者有典型的LFLG(左心室射血分数降低)。

在88±45个月的平均±SD随访期间,评估了8162名可分类为严重AS亚型患者的全因死亡率和心血管相关死亡率。这些组患者的实际1年和5年全因死亡率各不相同,在高梯度严重AS患者分别为15.8%和49.2%,在正常流量的低梯度严重AS患者为11.6%和53.6%,在伴有相互矛盾LFLG的重度AS患者中为16.9%和58.8%,在典型LFLG重度AS患者中为30.5%和72.9%。与高梯度重度AS患者相比,正常流量的低梯度重度AS患者经年龄和性别调整的5年死亡风险风险比为0.94(95%CI为0.85-1.03);在伴有相互矛盾LFLG的重度AS患者中为1.01(95%CI为0.92-1.12);以及在典型LFLG重度AS患者中为1.65(95%CI为1.48-1.84)。

由此可见,在常规临床诊疗实践中,大约一半伴有重度AS超声心动图特征的患者具有低梯度血流动力学,这与长期死亡率相关,并与高梯度重度AS相当或更差。最差的患者存活率与典型的LFLG严重AS相关。

原始出处:

Afik D. Snir.et al.Prevalence and Outcomes of Low‐Gradient Severe Aortic Stenosis—From the National Echo Database of Australia.JAHA.2021.https://www.ahajournals.org/doi/full/10.1161/JAHA.121.021126

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    2021-11-03 zhaohui6731
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