■在中度/重度主动脉瓣狭窄(AS)中,已经提出了基于瓣膜外损伤程度的心脏损伤分期分类的预后价值。
■本研究的目的是评估主动脉手术或经导管主动脉瓣置换术(AVR)后AS患者的心脏损伤分期与死亡率之间的关系。
■我们对截至2023年2月发表的研究中的Kaplan-Meier衍生的重建事件时间数据进行了汇总荟萃分析。
■总共,16项研究(n=14,499)符合我们的资格标准,包括12,282例有症状的重度AS患者和2,217例无症状的重度/中度AS患者。对于有症状的重度AS患者,全因死亡率为24.0%,27.7%,38.0%,56.3%,心脏损害0、1、2、3和4期患者的5年分别为57.3%(以0期为参考;1期HR:1.30[95%CI:1.03-1.64];P=0.029;2期:1.74[95%CI:1.41-2.16];P<0.001;3期:2.92[95%CI:2.35-3.64];P<0.001,95%CI<0.001,和对于无症状中度/重度AS患者,全因死亡率为19.3%,36.9%,51.7%,在第0、1、2和3~4期的患者中,第8年分别为67.8%(第1阶段的HR:1.70[95%CI:1.21~2.38];P=0.002;第2阶段:2.20[95%CI:1.60~3.02];P<0.001;第3~4阶段:3.90[95%CI:2.79~5.47];P<0.001)。
■在AS的症状和严重程度范围内接受AVR的患者中,心脏损害基线分期对预后有重要意义.在接受AVR的患者中进行的汇总荟萃分析提示,对于中度或重度AS患者的治疗时机和选择,可以考虑对基线心脏损伤进行分期,以确定是否需要早期AVR或辅助药物治疗以预防不可逆的心脏损伤并改善长期预后。
UNASSIGNED: The prognostic value of cardiac damage staging classification based on the extent of extravalvular damage has been proposed in moderate/severe aortic stenosis (AS).
UNASSIGNED: The purpose of this study was to assess the association of cardiac damage staging with mortality across the spectrum of patients with AS following aortic surgical or transcatheter aortic valve replacement (AVR).
UNASSIGNED: We conducted a pooled meta-analysis of Kaplan-Meier-derived reconstructed time-to-event data from studies published through February 2023.
UNASSIGNED: In total, 16 studies (n = 14,499) met our eligibility criteria and included 12,282 patients with symptomatic severe AS and 2,217 patients with asymptomatic severe/moderate AS. For patients with symptomatic severe AS, all-cause mortality was 24.0%, 27.7%, 38.0%, 56.3%, and 57.3% at 5 years in patients with cardiac damage stage 0, 1, 2, 3, and 4, respectively (stage 0 as reference; HR in stage 1: 1.30 [95% CI: 1.03-1.64]; P = 0.029; stage 2: 1.74 [95% CI: 1.41-2.16]; P < 0.001; stage 3: 2.92 [95% CI: 2.35-3.64]; P < 0.001, and stage 4: 3.51 [95% CI: 2.79-4.41]; P < 0.001). For patients with asymptomatic moderate/severe AS, all-cause mortality was 19.3%, 36.9%, 51.7%, and 67.8% at 8 years in patients with cardiac damage stage 0, 1, 2, and 3 to 4, respectively (HR in stage 1: 1.70 [95% CI: 1.21-2.38]; P = 0.002; stage 2: 2.20 [95% CI: 1.60-3.02]; P < 0.001; and stage 3 to 4: 3.90 [95% CI: 2.79-5.47]; P < 0.001).
UNASSIGNED: In patients undergoing AVR across the symptomatic and severity spectrum of AS, cardiac damage staging at baseline has important prognostic implications. This pooled meta-analysis in patients undergoing AVR suggests that staging of baseline cardiac damage could be considered for timing and selection of therapy in patients with moderate or severe AS to determine the need for earlier AVR or adjunctive pharmacotherapy to prevent irreversible cardiac damage and improve the long-term prognosis.