■尽管射血分数正常,但多达30%的严重主动脉瓣狭窄(SAS)患者(主动脉瓣面积指数[AVAi]<0.6cm2/m2)表现出低的跨瓣梯度。关于该实体的预后意义存在激烈的争论。
■本研究的目的是比较不一致低梯度SAS(DLG-SAS)与中度主动脉瓣狭窄(MAS)和高梯度SAS(HG-SAS)患者的预后。
■我们使用BEL-F-ASt(比利时-法国-主动脉狭窄)注册表,包括连续的AS患者。比较了临床和影像学变量的总体和匹配(逆概率加权和倾向评分匹配)后的生存率。该分析首先在总体人群(n=2,582)中进行,然后在未手术患者人群(n=1,812)中进行。
■后逆概率加权匹配,3组平衡。MAS的五年生存率优于DLG-SAS和HG-SAS患者(58.9%vs47%vs41.2%,P<0.001)。在未手术的患者中获得了类似的结果(54.1%vs37.9%vs28.1%,P<0.001)。探讨MG(≤40vs>40mmHg)和AVAi(<0.6vs≥0.6cm2/m2)对结局的影响,比较了HG-vsDLG-SAS和MAS-DLG-SAS的倾向评分匹配队列的生存率.与MG匹配后,MAS的生存率优于DLG-SAS(52%vs40%,P<0.001)。在匹配AVAi之后,DLG-SAS患者的生存率优于HG-SAS患者(45%vs33%,P<0.001)。
■DLG-SAS患者的生存率优于HG-SAS,比MAS患者的生存率差。在可比的MG,AVAi越低,预后越差,而在类似的AVAi,MG越高,预后越差.这些数据表明DLG-SAS是疾病连续体中的中间形式。
UNASSIGNED: Up to 30% of patients with severe aortic stenosis (SAS) (indexed aortic valve area [AVAi] <0.6 cm2/m2) exhibit low-transvalvular gradient despite normal ejection fraction. There is intense debate regarding the prognostic significance of this entity.
UNASSIGNED: The purpose of this study was to compare the outcome of patients with discordant low-gradient SAS (DLG-SAS) vs moderate aortic stenosis (MAS) and high-gradient SAS (HG-SAS).
UNASSIGNED: We used the BEL-F-ASt (Belgium-France-Aortic Stenosis) registry including consecutive patients with AS. Survival was compared overall and after
matching (inverse probability weighting and propensity-score
matching) for clinical and imaging variables. The analysis was first performed in the overall population (n = 2,582) and then in the population of unoperated patients (n = 1,812).
UNASSIGNED: After-inverse probability weighting-
matching, the 3 groups were balanced. Five-year survival was better in MAS than in DLG-SAS and HG-SAS-patients (58.9% vs 47% vs 41.2%, P < 0.001). Similar results were obtained in unoperated patients (54.1% vs 37.9% vs 28.1%, P < 0.001). To explore the impact of MG (≤40 vs >40 mmHg) and AVAi (<0.6 vs ≥0.6 cm2/m2) on outcomes, survival of propensity score-matched cohorts of HG-vs DLG-SAS and MAS vs DLG-SAS were compared. After
matching for MG, survival was better in MAS than in DLG-SAS (52% vs 40%, P < 0.001). After
matching for AVAi, survival was better in DLG-SAS than in HG-SAS patients (45% vs 33%, P < 0.001).
UNASSIGNED: Survival of DLG-SAS is better than that of HG-SAS and worse than that of MAS patients. At comparable MG, the lower the AVAi, the worse the prognosis, whereas at comparable AVAi, the higher the MG, the worse the prognosis. These data argue that DLG-SAS is an intermediate form in the disease continuum.