{"title":"无症状严重主动脉瓣狭窄年轻患者的治疗选择：一项多中心回顾性队列研究","authors":"Yu Mao, Yang Liu, Mengen Zhai, Ping Jin, Fangyao Chen, Yuhui Yang, Gejun Zhang, Xiaoke Shang, Zhao Jian, Haibo Zhang, Lai Wei, Jian Liu, Yingqiang Guo, Xiangbin Pan, Yongjian Wu, Nicolo Piazza, Jian Yang","doi":"10.1186/s40001-025-03227-6","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The treatment of patients with asymptomatic severe aortic stenosis (SAS) with left ventricular ejection fraction (LVEF) retention remains controversial.</p><p><strong>Objective: </strong>The study aimed to evaluate the safety and efficacy of these three treatment modalities and to provide evidence for their clinical application and promotion.</p><p><strong>Methods: </strong>This multicenter retrospective study included asymptomatic patients with SAS who accepted treatment [defined as normal left ventricular function, aortic valve area ≤ 1.0 cm<sup>2</sup>, peak velocity (V<sub>max</sub>) ≥ 4.0 m/s or mean pressure gradient ≥ 40 mmHg]. Patients were divided into the transcatheter aortic valve replacement (TAVR) group, the surgical aortic valve replacement (SAVR) group, and the conservative treatment group. The primary end point was all-cause mortality during the follow-up period.</p><p><strong>Results: </strong>During follow-up of 66.5 (interquartile range: 63.1-69.2) months, the incidence of the primary end point was lower in the TAVR group than in the conservative treatment group (33.3% vs. 46.4%, P = 0.023), and the incidence of major adverse cardiovascular events was reduced in the SAVR group (12.8% vs. 22.3%, P = 0.047). The incidences of the primary end point (37.3% vs. 60.4%, P < 0.001) and stroke (19.0% vs. 40.7%, P < 0.001) were significantly lower in patients who converted to aortic valve replacement (AVR) compared with those who did not convert to AVR.</p><p><strong>Conclusions: </strong>Early AVR improved both primary and secondary end points compared with patients having conservative treatments. Conversion to AVR during conservative treatment was found to be more likely to bring net clinical benefits for such patients.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Protocol Registration System NCT02917980.</p>","PeriodicalId":11949,"journal":{"name":"European Journal of Medical Research","volume":"30 1","pages":"966"},"PeriodicalIF":3.4000,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12522824/pdf/","citationCount":"0","resultStr":"{\"title\":\"Treatment options for young patients with asymptomatic severe aortic stenosis: a multicenter retrospective cohort study.\",\"authors\":\"Yu Mao, Yang Liu, Mengen Zhai, Ping Jin, Fangyao Chen, Yuhui Yang, Gejun Zhang, Xiaoke Shang, Zhao Jian, Haibo Zhang, Lai Wei, Jian Liu, Yingqiang Guo, Xiangbin Pan, Yongjian Wu, Nicolo Piazza, Jian Yang\",\"doi\":\"10.1186/s40001-025-03227-6\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>The treatment of patients with asymptomatic severe aortic stenosis (SAS) with left ventricular ejection fraction (LVEF) retention remains controversial.</p><p><strong>Objective: </strong>The study aimed to evaluate the safety and efficacy of these three treatment modalities and to provide evidence for their clinical application and promotion.</p><p><strong>Methods: </strong>This multicenter retrospective study included asymptomatic patients with SAS who accepted treatment [defined as normal left ventricular function, aortic valve area ≤ 1.0 cm<sup>2</sup>, peak velocity (V<sub>max</sub>) ≥ 4.0 m/s or mean pressure gradient ≥ 40 mmHg]. Patients were divided into the transcatheter aortic valve replacement (TAVR) group, the surgical aortic valve replacement (SAVR) group, and the conservative treatment group. The primary end point was all-cause mortality during the follow-up period.</p><p><strong>Results: </strong>During follow-up of 66.5 (interquartile range: 63.1-69.2) months, the incidence of the primary end point was lower in the TAVR group than in the conservative treatment group (33.3% vs. 46.4%, P = 0.023), and the incidence of major adverse cardiovascular events was reduced in the SAVR group (12.8% vs. 22.3%, P = 0.047). The incidences of the primary end point (37.3% vs. 60.4%, P < 0.001) and stroke (19.0% vs. 40.7%, P < 0.001) were significantly lower in patients who converted to aortic valve replacement (AVR) compared with those who did not convert to AVR.</p><p><strong>Conclusions: </strong>Early AVR improved both primary and secondary end points compared with patients having conservative treatments. Conversion to AVR during conservative treatment was found to be more likely to bring net clinical benefits for such patients.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Protocol Registration System NCT02917980.</p>\",\"PeriodicalId\":11949,\"journal\":{\"name\":\"European Journal of Medical Research\",\"volume\":\"30 1\",\"pages\":\"966\"},\"PeriodicalIF\":3.4000,\"publicationDate\":\"2025-10-14\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12522824/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"European Journal of Medical Research\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1186/s40001-025-03227-6\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"MEDICINE, RESEARCH & EXPERIMENTAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"European Journal of Medical Research","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1186/s40001-025-03227-6","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"MEDICINE, RESEARCH & EXPERIMENTAL","Score":null,"Total":0}
Treatment options for young patients with asymptomatic severe aortic stenosis: a multicenter retrospective cohort study.
Background: The treatment of patients with asymptomatic severe aortic stenosis (SAS) with left ventricular ejection fraction (LVEF) retention remains controversial.
Objective: The study aimed to evaluate the safety and efficacy of these three treatment modalities and to provide evidence for their clinical application and promotion.
Methods: This multicenter retrospective study included asymptomatic patients with SAS who accepted treatment [defined as normal left ventricular function, aortic valve area ≤ 1.0 cm2, peak velocity (Vmax) ≥ 4.0 m/s or mean pressure gradient ≥ 40 mmHg]. Patients were divided into the transcatheter aortic valve replacement (TAVR) group, the surgical aortic valve replacement (SAVR) group, and the conservative treatment group. The primary end point was all-cause mortality during the follow-up period.
Results: During follow-up of 66.5 (interquartile range: 63.1-69.2) months, the incidence of the primary end point was lower in the TAVR group than in the conservative treatment group (33.3% vs. 46.4%, P = 0.023), and the incidence of major adverse cardiovascular events was reduced in the SAVR group (12.8% vs. 22.3%, P = 0.047). The incidences of the primary end point (37.3% vs. 60.4%, P < 0.001) and stroke (19.0% vs. 40.7%, P < 0.001) were significantly lower in patients who converted to aortic valve replacement (AVR) compared with those who did not convert to AVR.
Conclusions: Early AVR improved both primary and secondary end points compared with patients having conservative treatments. Conversion to AVR during conservative treatment was found to be more likely to bring net clinical benefits for such patients.
Trial registration: ClinicalTrials.gov Protocol Registration System NCT02917980.
期刊介绍：
European Journal of Medical Research publishes translational and clinical research of international interest across all medical disciplines, enabling clinicians and other researchers to learn about developments and innovations within these disciplines and across the boundaries between disciplines. The journal publishes high quality research and reviews and aims to ensure that the results of all well-conducted research are published, regardless of their outcome.
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