이달의 증례
| Early Aortic Valve Replacement in Symptomatic Normal-Flow, Low-Gradient Severe Aortic Stenosis: A Propensity Score–Matched Retrospective Cohort Study | |||
|---|---|---|---|
| 년도 | 2023년 11월 | ||
| 카테고리 | 이달의 kcj Hot Article | ||
| 저자 | Kyu Kim, MD,1 Iksung Cho, MD, PhD,1 Kyu-Yong Ko, MD,1 Seung-Hyun Lee, MD, PhD,2 Sak Lee, MD, PhD,2 Geu-Ru Hong, MD, PhD,1 Jong-Won Ha, MD, PhD,1 and Chi Young Shim, MD, PhD1 | ||
| 소속 | 1Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
2Department of Cardiothoracic Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea. |
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| 첨부파일 1 | img_231115.jpg | ||
- 관리자
- 등록일 : 2023.11.15
- Hit 254
Background and Objectives
Aortic valve replacement (AVR) is considered a class I indication for symptomatic severe aortic stenosis (AS). However, there is little evidence regarding the potential benefits of early AVR in symptomatic patients diagnosed with normal-flow, low-gradient (NFLG) severe AS.
Methods
Two-hundred eighty-one patients diagnosed with symptomatic NFLG severe AS (stroke volume index ≥35 mL/m2, mean transaortic pressure gradient <40 mmHg, peak transaortic velocity <4 m/s, and aortic valve area <1.0 cm2) between January 2010 and December 2020 were included in this retrospective study. After performing 1:1 propensity score matching, 121 patients aged 75.1±9.8 years (including 63 women) who underwent early AVR within 3 months after index echocardiography, were compared with 121 patients who received conservative care. The primary outcome was a composite of all-cause death and heart failure (HF) hospitalization.
Results
During a median follow-up of 21.9 months, 48 primary outcomes (18 in the early AVR group and 30 in the conservative care group) occurred. The early AVR group demonstrated a significantly lower incidence of primary outcomes (hazard ratio [HR], 0.52; 95% confidence interval [CI], 0.29–0.93; p=0.028); specifically, there was no significant difference in all-cause death (HR, 0.51; 95% CI, 0.23–1.16; p=0.110), although the early AVR group showed a significantly lower incidence of hospitalization for HF (HR, 0.43; 95% CI, 0.19–0.95, p=0.037). Subgroup analyses supported the main findings.
Conclusions
An early AVR strategy may be beneficial in reducing the risk of a composite outcome of death or hospitalization for HF in symptomatic patients with NFLG severe AS. Future randomized studies are required to validate and confirm our findings.
본문바로가기 https://e-kcj.org/DOIx.php?id=10.4070/kcj.2023.0022
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