| BackgroundAortic valve stenosis has become the most common primary heart valve disease.Aortic valve replacement is the effective treatment for patients with severe aortic valve stenosis.Euro SCOREⅡhas been used clinically to evaluate perioperative mortality in patients undergoing aortic valve implantation.However,it is unknown whether Euro SCOREⅡwould be useful for predicting outcome in patients with aortic valve stenosis.And it is also unknown whether aortic valve replacement or conservative medication has different effects on the prognosis of patients with aortic valve stenosis in different Euro SCOREⅡgroups.Objective1.To explore the value of Euro SCOREⅡin predicting the risk of all-cause death in patients with aortic valve stenosis.2.To compare the effects of aortic valve replacement and conservative medication on the prognosis of patients with aortic valve stenosis in different Euro SCOREⅡgroups.MethodThe study included patients with aortic valve stenosis diagnosed by echocardiography in the second affiliated Hospital of Medical College of Shantou University from January1st,2013 to February 1st,2022 and the first affiliated Hospital of Sun Yat-sen University from June 1st,2019 to December 1st,2020 and it is a Retrospective analysis.The baseline data were collected and the survival conditions of the patients were followed up by telephone.With Euro SCOREⅡ4%as the critical value,all patients were divided into two groups:Euro SCOREⅡ<4%and Euro SCOREⅡ≥4%.The baseline data of the two groups were compared,and the survival curve was drawn to compare the difference of all-cause mortality between the two groups.Then the two groups were divided into subgroups according to whether or not valve replacement was performed.Then the COX proportional hazard model was used to analyze the factors affecting all-cause death in patients with Aortic valve stenosis.Finally,the echocardiographic findings of patients with aortic valve stenosis of different genders were compared and discussed.Results(1)The overall cumulative survival rate in the high-risk group was significantly lower than that in the low risk group(x~2=10.074,P=0.002).(2)In the high-risk group,compared with the patients without AVI(55.2%),the cumulative survival rate of patients with AVI was 78.2%,and the difference was statistically significant(P=0.001).In the low-risk group,the cumulative survival rate of patients with AVI was also significantly higher than those without AVI(92.3%vs 81.8%,P=0.013).(3)Euro SCOREⅡand AVR were predictors of all-cause death in patients with aortic valve stenosis,and HR(95%CI)were 3.260(1.647-6.454)and 2.639(1.058-6.586)respectively.There was an interaction between Euro SCOREⅡand gender(P=0.029).(4)In females,compared with Euro SCOREⅡ<4%,patients with aortic stenosis with Euro SCOREⅡ≥4%have an increased risk of all-cause death.The HRs(95%CI)were 7.370(2.483-21.869).The difference was statistically significant(P<0.05),but there was no significant difference between the two groups in males(P=0.559).(5)Compared with male patients,the transvalvular pressure gradient of aortic valve in was higher[74.71(59.00-98.00)vs 55.00(33.00-80.14),P<0.001],the velocity was faster[(4.27±0.95)vs(3.76±1.06),P=0.002],the LVEF was lower[56.00(48.00-65.00)vs 64.00(56.00-70.00),P=0.002]in female patients.The difference between the measured value of LVDs(mm)and the normal value in male patients was greater than that in the female patients[1.00(-6.00-9.00)vs-3.00(-8.00-0.20),P=0.002].Compared with male patients,the IVS and LVPW were greater than that in the female patients[12.00(11.00-14.00)vs11.00(9.00-13.00),P=0.005;11.07±2.19 vs 10.12±2.05,P=0.002].Conclusion(1)Euro SCOREⅡmay be used to evaluate and predict the prognosis of patients with aortic valve stenosis.(2)Compared with conservative treatment,aortic valve replacement can reduce the risk of death in patients with aortic valve stenosis.(3)The value of Euro SCOREⅡto predict the prognosis of patients with aortic valve stenosis has a gender difference. |
PDF Full Text Request