Table1_Risk prediction in patients with classical low-flow, low-gradient aortic stenosis undergoing surgical intervention.docx

IntroductionClassical low-flow, low-gradient aortic stenosis (LFLG-AS) is an advanced stage of aortic stenosis, which has a poor prognosis with medical treatment and a high operative mortality after surgical aortic valve replacement (SAVR). There is currently a paucity of information regarding the current prognosis of classical LFLG-AS patients undergoing SAVR and the lack of a reliable risk assessment tool for this particular subset of AS patients. The present study aims to assess mortality predictors in a population of classical LFLG-AS patients undergoing SAVR.MethodsThis is a prospective study including 41 consecutive classical LFLG-AS patients (aortic valve area ≤1.0 cm2, mean transaortic gradient 25 mmHg [2.0 (0.0–8.9) g vs. 8.5 (2.3–15.0) g; p = 0.034), and myocardium extracellular volume (ECV) and indexed ECV were similar between groups. The 30-day and 1-year mortality rates were 14.6% and 43.8%, respectively. The median follow-up was 4.1 (0.3–5.1) years. By multivariate analysis adjusted for FR, only the mean transaortic gradient was an independent predictor of mortality (hazard ratio: 0.923, 95% confidence interval: 0.864–0.986, p = 0.019). A mean transaortic gradient ≤25 mmHg was associated with higher all-cause mortality rates (log-rank p = 0.038), while there was no difference in mortality regarding FR status (log-rank p = 0.114).ConclusionsIn patients with classical LFLG-AS undergoing SAVR, the mean transaortic gradient was the only independent mortality predictor in patients with LFLG-AS, especially if ≤25 mmHg. The absence of left ventricular FR had no prognostic impact on long-term outcomes.

引言：经典低流量、低梯度主动脉瓣狭窄（LFLG-AS）是主动脉瓣狭窄的晚期阶段，其治疗预后不佳，经手术主动脉瓣置换术（SAVR）后手术死亡率高。目前关于接受SAVR的经典LFLG-AS患者当前预后的信息匮乏，且缺乏针对该特定亚组AS患者的可靠风险评估工具。本研究旨在评估接受SAVR的经典LFLG-AS患者群体中的死亡预测因子。
方法：这是一项包括41例连续的经典LFLG-AS患者（主动脉瓣面积≤1.0 cm²，平均跨主动脉梯度25 mmHg [2.0 (0.0–8.9) g vs. 8.5 (2.3–15.0) g；p=0.034]，两组之间心肌细胞外体积（ECV）和标准化ECV相似。30天和1年的死亡率分别为14.6%和43.8%。中位随访时间为4.1 (0.3–5.1) 年。通过调整FR的多因素分析，只有平均跨主动脉梯度是独立的死亡预测因子（风险比：0.923，95%置信区间：0.864–0.986，p=0.019）。平均跨主动脉梯度≤25 mmHg与更高的全因死亡率相关（log-rank p=0.038），而关于FR状态，死亡率无差异（log-rank p=0.114）。
结论：在经历SAVR的经典LFLG-AS患者中，平均跨主动脉梯度是LFLG-AS患者唯一的独立死亡预测因子，尤其是当其≤25 mmHg时。左心室FR的缺失对长期预后无预测影响。