Background

There are currently no established prognostic models for “low-gradient” severe aortic stenosis (AS), including those with low-flow, low-gradient (LFLG) or normal-flow, low-gradient (NFLG) severe AS. The “cardiac damage staging classification” has been validated as a clinically useful prognostic tool for high-gradient severe AS but not yet for these other common subtypes of severe AS, LFLG and NFLG.

Methods

The authors analyzed data from the National Echo Database of Australia, a large national, multicenter registry with individual data linkage to mortality. Of 192,060 adults (mean age, 62.8 ± 17.8 years) with comprehensive ultrasound profiling of the native aortic valve studied between 2000 and 2019, 12,013 (6.3%) had severe AS. On the basis of standard echocardiographic parameters, 5,601 patients with high-gradient, 611 with classical and 959 with paradoxical LFLG, and 911 with NFLG severe AS were identified. Mean follow-up was 88 ± 45 months. All-cause and cardiovascular-related mortality were assessed for each group on an adjusted basis (age and sex) and analyzed by cardiac damage stage.

Results

Patients with LFLG AS had greater associated cardiac damage at diagnosis (stages 3 and 4 in 34% of those with classical LFLG, 22.5% of those with paradoxical LFLG, 15.5% of those with NFLG, and 14% of those with high-gradient AS; P < .001). For all four major subtypes of severe AS, there was a progressive increase in 1- and 5-year mortality with increasing cardiac damage score. For example, for paradoxical LFLG severe AS, compared with stage 0 patients, adjusted 1-year all-cause mortality was 22% higher in stage 1 patients, 55% higher in stage 2 patients (P = .095), and 155% higher in stage 3 and 4 patients (P < .001). Among patients with classical LFLG severe AS, compared with stage 1 patients, adjusted 1-year all-cause mortality was 55% higher in stage 2 patients (P = .018) and 100% higher in stage 3 and 4 patients (P < .001).

Conclusions

Regardless of severe AS subtype, increasing severity denoted by the cardiac damage staging classification is strongly associated with increasing mortality risk.

中文翻译：

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心脏损伤分期分类预测严重主动脉瓣狭窄所有主要亚型的预后：来自澳大利亚国家回声数据库的见解

背景

目前还没有针对“低梯度”严重主动脉瓣狭窄 (AS) 建立的预后模型，包括低流量、低梯度 (LFLG) 或正常流量、低梯度 (NFLG) 的严重主动脉瓣狭窄。“心脏损伤分期分类”已被验证为临床上有用的高梯度重度 AS 预后工具，但尚未用于重度 AS、LFLG 和 NFLG 的其他常见亚型。

方法

作者分析了来自澳大利亚国家回声数据库的数据，这是一个大型的全国性多中心登记处，个人数据与死亡率相关。在 2000 年至 2019 年间对天然主动脉瓣进行全面超声分析的 192,060 名成人（平均年龄，62.8 ± 17.8 岁）中，12,013 人（6.3%）患有严重的 AS。根据标准超声心动图参数，确定了 5,601 名高梯度患者、611 名经典患者和 959 名反常 LFLG 患者以及 911 名 NFLG 重度 AS。平均随访时间为 88 ± 45 个月。在调整的基础上（年龄和性别）评估每组的全因死亡率和心血管相关死亡率，并按心脏损伤阶段进行分析。

结果

LFLG AS 患者在诊断时具有更大的相关心脏损伤（34% 的经典 LFLG、22.5% 的矛盾 LFLG、15.5% 的 NFLG 和 14% 的高梯度 AS ; P  < .001)。对于严重 AS 的所有四种主要亚型，随着心脏损伤评分的增加，1 年和 5 年死亡率逐渐增加。例如，对于矛盾的 LFLG 重度 AS，与 0 期患者相比，1 期患者调整后的 1 年全因死亡率高 22%，2 期患者高 55% ( P  = .095)，高 155% 3 期和 4 期患者（P < .001）。在经典 LFLG 重度 AS 患者中，与 1 期患者相比，2 期患者调整后的 1 年全因死亡率高 55% ( P  = .018)，3 期和 4 期患者高 100% ( P  < . 001）。

结论

无论严重的 AS 亚型如何，由心脏损伤分期分类表示的严重程度的增加与死亡风险的增加密切相关。