Prognostic value of aortic valve calcification in non-severe aortic stenosis with preserved ejection fraction.

IF 6.7 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

European Heart Journal - Cardiovascular Imaging Pub Date : 2024-09-30 DOI:10.1093/ehjci/jeae145

Zi Ye, Christopher G Scott, Rohan A Gajjar, Thomas Foley, Marie-Annick Clavel, Vuyisile T Nkomo, S Allen Luis, William R Miranda, Ratnasari Padang, Sorin V Pislaru, Maurice Enriquez-Sarano, Hector I Michelena

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引用次数: 0

Abstract

Aims: Aortic valve calcification (AVC) is prognostic in patients with aortic stenosis (AS). We assessed the AVC prognostic value in non-severe AS patients.

Methods and results: We conducted a retrospective study of 395 patients with non-severe AS, LVEF ≥ 50%. The Agatston method was used for CT AVC assessment. The log-rank test determined the best AVC cut-offs for survival under medical surveillance: 1185 arbitrary unit (AU) in men and 850 AU in women, lower than the established cut-offs for severe AS (2064 AU in men and 1274 AU in women). Patients were divided into 3 AVC groups based on these cut-offs: low (<1185 AU in men and <850 AU in women), sub-severe (1185-2064 AU in men and 850-1274 AU in women), and severe (>2064 AU in men and >1274 AU in women). Of 395 patients (mean age 73 ± 12 years, 60.5% men, aortic valve area 1.23 ± 0.30 cm2, mean pressure gradient 28 ± 8 mmHg), 218 underwent aortic valve intervention (AVI) and 158 deaths occurred during follow-up, 82 before AVI. Median survival time under medical surveillance was 2.1 (0.7-4.9) years. Compared with the low AVC group, both sub-severe and severe AVC groups had higher risk for all-cause death under medical surveillance after comprehensive adjustment including echocardiographic AS severity and coronary artery calcium score (all P ≤ 0.006); while mortality risk was similar between sub-severe and severe AVC groups (all P ≥ 0.2). This mortality risk pattern persisted in the overall survival analysis after adjustment for AVI. AVI was protective of all-cause death in the sub-severe and severe AVC (all P ≤ 0.01), but not in the low AVC groups.

Conclusion: Sub-severe AVC is a robust risk stratification parameter in patients with non-severe AS and may inform AVI timing.

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保留射血分数的非重度主动脉瓣狭窄患者主动脉瓣钙化的预后价值

背景主动脉瓣钙化（AVC）是主动脉瓣狭窄（AS）患者的预后指标。我们评估了主动脉瓣钙化在非重度主动脉瓣狭窄患者中的预后价值：我们对395例左心室射血分数≥50%的非重度AS患者进行了回顾性研究。计算机断层扫描 AVC 评估采用 Agatston 方法。对数秩检验确定了在医疗监控下存活的最佳AVC临界值：男性为1185 AU，女性为850 AU，低于重症AS的既定临界值（男性为2064AU，女性为1274 AU）。根据这些分界线将患者分为三组：低AVC组（男性2064AU，女性>1274）。在 395 名患者（平均年龄为 73 ± 12 岁，60.5% 为男性，主动脉瓣面积为 1.23 ± 0.30 平方厘米，平均压力梯度为 28 ± 8 mmHg）中，218 人接受了主动脉瓣介入治疗，158 人在随访期间死亡，82 人在主动脉瓣介入治疗前死亡。医疗监护下的中位生存时间为 2.1[0.7-4.9] 年。与低AVC组相比，经超声心动图AS严重程度和冠状动脉钙化评分等综合调整后，亚重度和重度AVC组在医学监护下的全因死亡风险更高（均P≤0.006）；而亚重度和重度AVC组的死亡风险相似（均P≥0.2）。对 AVI 进行调整后，这种死亡风险模式在总体生存分析中依然存在。在亚重度和重度AVC组中，AVI对全因死亡有保护作用（所有P均≤0.01），但在低AVC组中没有保护作用：亚重度AVC是非重度强直性脊柱炎患者的一个可靠的风险分层参数，可为AVI的时机选择提供参考。

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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来源期刊

European Heart Journal - Cardiovascular Imaging CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

11.60

自引率

9.70%

发文量

708

审稿时长

4-8 weeks

期刊介绍： European Heart Journal – Cardiovascular Imaging is a monthly international peer reviewed journal dealing with Cardiovascular Imaging. It is an official publication of the European Association of Cardiovascular Imaging, a branch of the European Society of Cardiology. The journal aims to publish the highest quality material, both scientific and clinical from all areas of cardiovascular imaging including echocardiography, magnetic resonance, computed tomography, nuclear and invasive imaging. A range of article types will be considered, including original research, reviews, editorials, image focus, letters and recommendation papers from relevant groups of the European Society of Cardiology. In addition it provides a forum for the exchange of information on all aspects of cardiovascular imaging.