Abstract

Background. Moderate aortic stenosis (AS) increases left ventricular afterload and results in unfavorable outcomes in patients with reduced left ventricular ejection fraction (LVEF). Velocity ratio (VR) may be appropriate for the evaluation of aortic valve (AV) hemodynamics because of the low dependence on flow. Therefore, this study investigated the usefulness of VR on the clinical outcomes of such patients. Method. Clinical data of patients with moderate AS (AV area, 0.60–0.85 cm²/m²; peak AV velocity, 2.0–4.0 m/s) and reduced LVEF (LVEF 20–50%) were analyzed during 2010–2018. VR was calculated as peak left ventricular outflow tract velocity/peak AV velocity. The primary endpoint included all-cause death, heart failure hospitalization, and AV replacement. Results. In total, 104 patients (mean age, 75.9 ± 7.0 years; 62.5% men) were included. LVEF was 39.5% ± 7.8%. The AV area was 0.72 ± 0.08 cm²/m², peak AV velocity was 2.59 ± 0.40 m/s, and VR was 0.30 ± 0.07. The follow-up period was 1.7 (0.5–3.5) years. Kaplan–Meier estimates for the endpoint were 59.9% at 3 years. Multivariable analysis revealed that VR (hazard ratio, 0.947; 95% confidence interval, 0.905–0.990; p = .018) was significantly related to this endpoint. Patients with a VR <0.25 had significantly higher incidence rates of the endpoint than those with a VR ≥0.25 (85.6% versus 47.8% at 3 years; p < .001). Conclusions. Patients with moderate AS and reduced LVEF have unfavorable clinical outcomes, particularly those with low VR.

摘要

背景。中度主动脉瓣狭窄 (AS) 会增加左心室后负荷，并导致左心室射血分数 (LVEF) 降低的患者出现不利结果。由于对流量的依赖性较低，速度比 (VR) 可能适用于评估主动脉瓣 (AV) 血流动力学。因此，本研究调查了 VR 对此类患者临床结果的有用性。方法。中度 AS（AV 面积，0.60–0.85 cm ² /m ²; 2010-2018 年期间分析了 AV 峰值速度，2.0-4.0 m/s）和降低的 LVEF（LVEF 20-50%）。VR 计算为峰值左心室流出道速度/峰值 AV 速度。主要终点包括全因死亡、心力衰竭住院和 AV 置换。结果。总共包括 104 名患者（平均年龄，75.9 ± 7.0 岁；62.5% 男性）。LVEF 为 39.5% ± 7.8%。AV 面积为 0.72 ± 0.08 cm ² /m ²，AV 峰值速度为 2.59 ± 0.40 m/s，VR 为 0.30 ± 0.07。随访期为 1.7 (0.5-3.5) 年。Kaplan-Meier 对终点的估计在 3 年时为 59.9%。多变量分析显示 VR（风险比，0.947；95% 置信区间，0.905–0.990；p = .018) 与该终点显着相关。VR <0.25 的患者终点发生率显着高于 VR ≥ 0.25 的患者（3 年时为 85.6% 对 47.8%；p  < .001）。结论。中度 AS 和 LVEF 降低的患者临床结果不佳，尤其是低 VR 患者。