Background-This study assessed the long-term outcome of a large, asymptomatic population with hemodynamically significant aortic stenosis(AS). Methods and Results-We identified 622 patients with isolated, asymptomatic...Background-This study assessed the long-term outcome of a large, asymptomatic population with hemodynamically significant aortic stenosis(AS). Methods and Results-We identified 622 patients with isolated, asymptomatic AS and peak systolic velocity ≥4 m/s by Doppler echocardiography who did not undergo surgery at the initial evaluation and obtained follow up(5.4±4.0 years) in all. Mean age(±SD) was 72±11 years; there were 384(62%) men. The probability of remaining free of cardiac symptoms while unoperated was 82%, 67%, and 33%at 1, 2, and 5 years, respectively. Aortic valve area and left ventricular hypertrophy predicted symptom development. During follow-up, 352(57%) patients were referred for aortic valve surgery and 265(43%) patients died, including cardiac death in 117(19%). The 1-, 2-, and 5-year probabilities of remaining free of surgery or cardiac death were 80%, 63%, and 25%, respectively. Multivariate predictors of all-cause mortality were age(hazard ratio HR , 1.05; P< 0.0001), chronic renal failure(HR, 2.41; P=0.004), inactivity(HR, 2.00; P=0.001), and aortic valve velocity(HR, 1.46; P=0.03). Sudden death without preceding symptoms occurred in 11(4.1%) of 270 unoperated patients. Patients with peak velocity ≥4.5 m/s had a higher likelihood of developing symptoms(relative risk, 1.34) or having surgery or cardiac death(relative risk, 1.48). Conclusions-Most patients with asymptomatic, hemodynamically significant AS will develop symptoms within 5 years. Sudden death occurs in≈1%/y. Age, chronic renal failure, inactivity, and aortic valve velocity are independently predictive of all-cause mortality.展开更多
We studied 536 patients with acute myocardial infarction and echocardiographic assessment of left ventricular systolic and diastolic function and measurement of right ventricular systolic pressure. On multivariable an...We studied 536 patients with acute myocardial infarction and echocardiographic assessment of left ventricular systolic and diastolic function and measurement of right ventricular systolic pressure. On multivariable analysis, the grade of diastolic function, mitral regurgitation severity, age, and wall motion score index were independent predictors of right ventricular systolic pressure, and an increase in right ventricular systolic pressure was independently predictive of mortality(hazard ratio 1.22 per 10 mm Hg, p< 0.0001), after adjustment for conventional risk factors and left ventricular function.展开更多
文摘Background-This study assessed the long-term outcome of a large, asymptomatic population with hemodynamically significant aortic stenosis(AS). Methods and Results-We identified 622 patients with isolated, asymptomatic AS and peak systolic velocity ≥4 m/s by Doppler echocardiography who did not undergo surgery at the initial evaluation and obtained follow up(5.4±4.0 years) in all. Mean age(±SD) was 72±11 years; there were 384(62%) men. The probability of remaining free of cardiac symptoms while unoperated was 82%, 67%, and 33%at 1, 2, and 5 years, respectively. Aortic valve area and left ventricular hypertrophy predicted symptom development. During follow-up, 352(57%) patients were referred for aortic valve surgery and 265(43%) patients died, including cardiac death in 117(19%). The 1-, 2-, and 5-year probabilities of remaining free of surgery or cardiac death were 80%, 63%, and 25%, respectively. Multivariate predictors of all-cause mortality were age(hazard ratio HR , 1.05; P< 0.0001), chronic renal failure(HR, 2.41; P=0.004), inactivity(HR, 2.00; P=0.001), and aortic valve velocity(HR, 1.46; P=0.03). Sudden death without preceding symptoms occurred in 11(4.1%) of 270 unoperated patients. Patients with peak velocity ≥4.5 m/s had a higher likelihood of developing symptoms(relative risk, 1.34) or having surgery or cardiac death(relative risk, 1.48). Conclusions-Most patients with asymptomatic, hemodynamically significant AS will develop symptoms within 5 years. Sudden death occurs in≈1%/y. Age, chronic renal failure, inactivity, and aortic valve velocity are independently predictive of all-cause mortality.
文摘We studied 536 patients with acute myocardial infarction and echocardiographic assessment of left ventricular systolic and diastolic function and measurement of right ventricular systolic pressure. On multivariable analysis, the grade of diastolic function, mitral regurgitation severity, age, and wall motion score index were independent predictors of right ventricular systolic pressure, and an increase in right ventricular systolic pressure was independently predictive of mortality(hazard ratio 1.22 per 10 mm Hg, p< 0.0001), after adjustment for conventional risk factors and left ventricular function.
