左心室射血分数正常的低压差“严重”主动脉瓣狭窄

Low Gradient “Severe” Aortic Stenosis with Preserved Left Ventricular Ejection Fraction

在发达国家,主动脉瓣狭窄(AS)是最常见的心脏瓣膜病,且随着人口老龄化,其发病率也越来越高。在临床决策中,对病程及病情严重性进行准确诊断非常重要。目前的诊疗指南虽然推荐使用跨瓣膜压差、最大流速及主动脉瓣口面积来判断疾病的严重程度,但疾病严重性分级不一致仍然是临床中常见的问题。近期研究表明,伴有低流速和/或低压差的患者病情较为严重,且预后较差。目前指南所推荐的诊治模式,可能会导致对病情估计不足,延误了心脏主动脉瓣膜置换术(AVR)的进行。因此,我们需对有这一富有挑战的临床疾病的患者认真进行评估,并制订个体化临床诊疗决策。

In developed nations,aortic stenosis(AS) is the most common valvular heart disease presentation,and its prevalence is increasing due to aging populations.Accurate diagnosis of the disease process and determination of its severity are essential in clinical decision-making.Although current guidelines recommend measuring transvalvular gradients,maximal velocity,and aortic valve area in determining the disease severity,inconsistent grading of disease severity remains a common problem in clinical practice.Recent studies suggest that patients with paradoxical low-flow and/or low-gradient,severe AS are at a more advanced stage of the disease process and have a poorer prognosis.This mode of presentation may lead to an underevaluation of symptoms and inappropriate delay of AVR.Therefore,this challenging clinical situation should be carefully assessed in particular in symptomatic patients and clinical decisions should be tailored individually.