Prediction of symptoms development and aortic valve replacement in patients with low gradient severe aortic stenosis

Daisuke Miyahara, M. Izumo, Yukio Sato, Tatsuro Shoji, Risako Murata, Ryutaro Oda, T. Okuno, S. Kuwata, Yoshihiro J. Akashi
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Abstract

Current evidence on the prognostic value of exercise stress echocardiography (ESE) in asymptomatic patients with low-gradient severe AS is limited. Therefore, this study aimed to elucidate its prognostic implications for patients with low-gradient severe AS and determine the added value of ESE in risk stratification for this population. This retrospective observational study included 122 consecutive asymptomatic patients with either moderate (mean pressure gradient [MPG] <40 mmHg and aortic valve area [AVA] 1.0–1.5 cm2) or low-gradient severe (MPG <40 mmHg and AVA <1.0 cm2) AS and preserved left ventricular ejection fraction (≥50%) who underwent ESE. All patients were followed up for AS-related events. Of 143 patients, 21 who met any exclusion criteria, including early interventions, were excluded, and 122 conservatively managed patients (76.5 [71.0–80.3] years; 48.3% male) were included in this study. During a median follow-up period of 989 (578–1571) days, 64 patients experienced AS-related events. Patients with low-gradient severe AS had significantly lower event-free survival rates than those with moderate AS (log-rank test, p<0.001). Multivariable Cox regression analysis showed that the mitral E/e’ ratio during exercise was independently associated with AS-related events (hazard ratio=1.075, p<0.001) in patients with low-gradient severe AS. This study suggests that asymptomatic patients with low-gradient severe AS have worse prognoses than those with moderate AS. Additionally, the mitral E/e’ ratio during exercise is a useful parameter for risk stratification in patients with low-gradient severe AS.
低梯度重度主动脉瓣狭窄患者症状发展和主动脉瓣置换术的预测
目前有关运动负荷超声心动图(ESE)对低梯度重度强直性脊柱炎无症状患者预后价值的证据有限。因此,本研究旨在阐明运动负荷超声心动图对低梯度重度 AS 患者预后的影响,并确定 ESE 在该人群风险分层中的附加价值。 这项回顾性观察研究纳入了 122 例连续接受 ESE 的无症状中度(平均压力梯度 [MPG] <40 mmHg,主动脉瓣面积 [AVA] 1.0-1.5 cm2)或低梯度重度(平均压力梯度 <40 mmHg,主动脉瓣面积 <1.0 cm2)AS 患者,这些患者的左室射血分数保留(≥50%)。所有患者均接受了 AS 相关事件的随访。在 143 例患者中,21 例符合任何排除标准(包括早期干预)的患者被排除在外,122 例保守治疗的患者(76.5 [71.0-80.3] 岁;48.3% 为男性)被纳入本研究。在989(578-1571)天的中位随访期间,64名患者发生了与强直性脊柱炎相关的事件。低梯度重度强直性脊柱炎患者的无事件生存率明显低于中度强直性脊柱炎患者(log-rank检验,P<0.001)。多变量考克斯回归分析显示,运动时二尖瓣E/e'比值与低梯度重度AS患者的AS相关事件独立相关(危险比=1.075,P<0.001)。 这项研究表明,无症状的低梯度重度强直性脊柱炎患者的预后比中度强直性脊柱炎患者差。此外,运动时的二尖瓣E/e'比值是对低梯度重度AS患者进行风险分层的有用参数。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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