瓣膜面积大于 1.0 平方厘米的高梯度主动脉瓣狭窄：被 "遗忘 "的不和谐血流动力学表型。

IF 12.8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS JACC. Cardiovascular imaging Pub Date : 2024-09-05 DOI:10.1016/j.jcmg.2024.07.025

Saki Ito, Jae K Oh, Hector I Michelena, Alexander C Egbe, Heidi M Connolly, Patricia A Pellikka, Vuyisile T Nkomo, Bradley R Lewis, William R Miranda

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引用次数: 0

摘要

背景：严重主动脉瓣狭窄（AS）的临床特征和预后是根据血液动力学表型描述的：本研究旨在调查主动脉瓣面积（AVA）大于1.0 cm2的高梯度（HG）主动脉瓣狭窄患者的临床特征和预后：方法：根据主动脉瓣面积（AVA）（cm2）、峰值速度（m/s）、收缩期平均压力阶差（MG）（mmHg）确定3209名患者：HG-AVA>1=>1.0、≥4和≥40，HG-AVA≤1=≤1.0、≥4和≥40；LG-AVA≤1（低阶差）=≤1.0，结果：HG-AVA>1的有230人（7.2%）。与其他患者相比，HG-AVA >1患者更年轻（70.2 ± 12.0岁），男性更多（85.7%），合并症更少，体表面积和卒中量更大（115 ± 19.3 mL），双尖瓣患病率更高（39.6%）。随访 944 天（Q1-Q3：27-2,212 天）后，1,523 人死亡。与 HG-AVA >1 组相比，HG-AVA ≤1（HR：1.4；95% CI：1.1-1.7）、LG-AVA ≤1（HR：2.8；95% CI：2.2-3.6）和中度 AS（HR：1.4；95% CI：1.1-1.7）组的全因死亡率较高。在对年龄、合并症、二尖瓣和心脏功能进行调整后，这些差异不再显著。在HG-AVA>1组中，对两组进行平衡后，主动脉瓣置换术患者的生存预后优于未行主动脉瓣置换术的患者（P<0.001）：HG-AVA>1患者的HG是由潜在的相对高流量状态引起的。这种情况的预后比其他情况好，这与潜在的年龄较小、全身和心脏状况较好有关，但主动脉瓣置换术仍可使这些患者受益。

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High-Gradient Aortic Stenosis With Valve Area >1.0 cm²: The "Forgotten" Discordant Hemodynamic Phenotype.

Background: Clinical features and outcomes in severe aortic stenosis (AS) have been described according to the hemodynamic phenotypes.

Objectives: The aim of this study was to investigate the clinical features and prognosis of patients with high-gradient (HG) AS with aortic valve area (AVA) >1.0 cm².

Methods: A total of 3,209 patients were identified according to AVA (cm²), peak velocity (m/s), systolic mean pressure gradient (MG) (mm Hg): HG-AVA >1 = >1.0, ≥4, and ≥40, HG-AVA ≤1 = ≤1.0, ≥4, and ≥40; LG-AVA ≤1 (low-gradient) = ≤1.0, <4, and <40; moderate AS = 1.0

Results: HG-AVA >1 accounted for 230 individuals (7.2%). Compared with others, patients with HG-AVA >1 were younger (70.2 ± 12.0 years), more frequently male (85.7%), had fewer comorbidities, larger body surface area and stroke volume (115 ± 19.3 mL), and had higher prevalence of bicuspid valve (39.6%). After a follow-up of 944 days (Q1-Q3: 27-2,212 days), 1,523 deaths occurred. Compared with the HG-AVA >1 group, all-cause mortality was higher in HG-AVA ≤1 (HR: 1.4; 95% CI: 1.1-1.7), LG-AVA ≤1 (HR: 2.8; 95% CI: 2.2-3.6), and moderate AS (HR: 1.4; 95% CI: 1.1-1.7). These differences were no longer significant after adjustment for age, comorbidities, bicuspid valve, and cardiac function. In the HG-AVA >1 group, patients with aortic valve replacement had better survival outcomes than those without aortic valve replacement (P < 0.001) after balancing the 2 groups.

Conclusions: The underlying relative high-flow status is responsible for HG in patients with HG-AVA >1. This profile has better prognosis than others, being related to underlying younger age and better general and cardiac conditions, but aortic valve replacement may still benefit these patients.

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来源期刊

JACC. Cardiovascular imaging CARDIAC & CARDIOVASCULAR SYSTEMS-RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

CiteScore

24.90

自引率

5.70%

发文量

330

审稿时长

4-8 weeks

期刊介绍： JACC: Cardiovascular Imaging, part of the prestigious Journal of the American College of Cardiology (JACC) family, offers readers a comprehensive perspective on all aspects of cardiovascular imaging. This specialist journal covers original clinical research on both non-invasive and invasive imaging techniques, including echocardiography, CT, CMR, nuclear, optical imaging, and cine-angiography. JACC. Cardiovascular imaging highlights advances in basic science and molecular imaging that are expected to significantly impact clinical practice in the next decade. This influence encompasses improvements in diagnostic performance, enhanced understanding of the pathogenetic basis of diseases, and advancements in therapy. In addition to cutting-edge research,the content of JACC: Cardiovascular Imaging emphasizes practical aspects for the practicing cardiologist, including advocacy and practice management.The journal also features state-of-the-art reviews, ensuring a well-rounded and insightful resource for professionals in the field of cardiovascular imaging.