摘要
中度主动脉瓣狭窄(AS)患者的预后存在争议,尤其是左室收缩功能(LVEF)在该人群的应用价值仍不明确.该研究旨在探讨中度AS患者的预后及左室收缩功能对其的预测价值.研究通过全国多中心前瞻性队列研究China-VHD连续纳入了来自中国46家三甲医院的万余名严重瓣膜病患者,其中513例为中度AS,并依据LVEF界值分为三组,分别为LVEF≤40%(LVEF显著降低组),40%<LVEF<50%(LVEF轻度降低组)和LVEF≥50%(LVEF正常组).入选患者53.0%为男性,平均年龄62.0岁.2年随访期内,中度AS患者生存率显著低于年龄和性别相匹配的中国人群的预期生存率(P<0.001).Cox回归模型提示LVEF分组始终是2年全因死亡和心源性死亡的最强预测因子(LVEF显著降低组,HR4.55,P=0.001;LVEF轻度降低组,HR3.02,P=0.020;LVEF正常组为对照/参考),相对死亡风险随着LVEF的降低而呈单调增加趋势,LVEF的最佳界值为60%.研究结果提示,LVEF降低是中度AS人群预后不佳的首要危险因素,今后或可考虑将LVEF低于60%作为进一步干预的界值。
Aortic stenosis(AS)is one of the most prevalent valvular heart diseases(VHD)among the elderly population,especially in Western countries[1,2].Current guidelines recommend aortic valve replacement(AVR)for patients with severe AS and reduced left ventricular ejection fraction,whereas there is no recommendation for patients with moderate AS[3].Early trials,regardless of their small study sample size,simple diagnostic techniques,lack of Asian population data,or retrospective design,have raised concerns over the poor prognosis of patients with moderate AS[4,5].Although several studies indicated that patients with moderate AS and left ventricular systolic dysfunction suffered worse outcomes and might benefit from early intervention,the optimal cut-off value of left ventricular ejection fraction(LVEF)for its impact on clinical outcomes among these patients is still unclear[6,7].
作者
刘先宝
朱齐丰
刘琼
许海燕
戴晗怡
周瑶瑶
陈俊
Stella Ng
鲁烨
赵延延
李喆
吴永健
王建安
China-VHD-研究团队
Xianbao Liu;Qifeng Zhu;Qiong Liu;Haiyan Xu;Hanyi Dai;Yaoyao Zhou;Jun Chen;Stella Ng;Ye Lu;Yanyan Zhao;Zhe Li;Yongjian Wu;Jian’an Wang;for the China-VHD Investigators(Department of Cardiology,The Second Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou 310009,China;Department of Cardiology,Fuwai Hospital,National Center for Cardiovascular Disease,Chinese Academy of Medical Science and Peking Union Medical College,Beijing 100037,China;Department of Cardiology,Affiliated Jinhua Hospital,Zhejiang University School of Medicine,Jinhua 321000,China;Medical Research&Biometrics Center,Fuwai Hospital,National Center for Cardiovascular Disease,Chinese Academy of Medical Science and Peking Union Medical College,Beijing 100037,China)
基金
supported by the National Key R&D Program of China(2020YFC2008100)
the Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences(2017-12M-3002)
the Zhejiang Province Science and Technology Department Key R&D Program(2021C03097 and 2022C03063)
the Binjiang Institute of Zhejiang University(ZY202205SMKY001)
the Natural Science Foundation of Zhejiang Province(LQ22H020008)。
