ABSTRACT
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Subject(s)
Humans , Female , Middle Aged , Aneurysm/diagnosis , Atrioventricular Block/complications , Heart-Assist Devices , Syncope/etiologySubject(s)
Atrioventricular Block/etiology , Heart Aneurysm/complications , Atrioventricular Block/diagnostic imaging , Echocardiography, Transesophageal , Electrocardiography , Female , Heart Aneurysm/diagnostic imaging , Heart Septal Defects, Ventricular/complications , Heart Septal Defects, Ventricular/diagnostic imaging , Heart Septum/diagnostic imaging , Humans , Middle Aged , Syncope/etiologyABSTRACT
Introducción. La evolución natural de la estenosis aórtica severa sintomática no intervenida presenta un pronóstico infausto. Nos proponemos estudiar en este análisis las variables clínicas, ecográficas y analíticas que pudieran estar asociadas con el pronóstico vital en este subgrupo de pacientes. Material y métodos. Estudio retrospectivo de pacientes ingresados en nuestro centro entre 2004 y 2008 por síntomas asociados a la presencia de una estenosis aórtica severa y no considerados para intervención quirúrgica. Se analizaron datos demográficos, enfermedades concomitantes, datos ecocardiográficos (fracción de eyección, gradiente transvalvular, área valvular), analíticos (hemoglobina, creatinina, péptido natriurético auricular) y el cálculo del euroscore logístico Resultados. Fueron recogidos 49 pacientes (73,5% mujeres), con una edad media de 82,2±5,5 años. La mediana de seguimiento fue 396,0 días, rango intercualítico 99,5731,0 días, con una mortalidad del 75,5%. En el análisis multivariante tan solo la medida de la fracción de eyección de ventrículo izquierdo por ecocardiografía fue un importante predictor en cuanto a la esperanza de vida (FE 3550%: HR 3,74, IC 95% 1,1112,65, p=0,034; FE<35%: HR 6,76, IC 95% 1,8624,52, p=0,004). Conclusión. La esperanza de vida en pacientes con estenosis aórtica severa sintomática y no intervenidos se encuentra muy limitada, con una alta mortalidad durante el primer año. La fracción de eyección se asocia de forma significativa con el pronóstico en este tipo de pacientes(AU)
Introduction. The natural outcome of untreated severe symptomatic aortic stenosis in the elderly patient is extremely poor. In this analysis we studied the clinical, ultrasound and analytical variables, that could be associated with the vital prognosis in this patient sub-group. Material and methods. A retrospective study of patients admitted to our hospital between 2004 and 2008 due to symptoms associated with the presence of a severe aortic stenosis and were not considered for surgery. Demographic, concomitant diseases, ultrasound (ejection fraction, transvalvular gradient, valve area) and laboratory analytical data (haemoglobin, creatinine, atrial natriuretic peptide) were analysed and the logistic euroscore was calculated. Results. A total of 49 patients were included (73.5% women), with a mean age of 82.2±5.5 years. The median follow up was 396.0 days, interquartile range 99.5731.0 days, with a mortality of 75.5%. In the multivariate analysis, only the left ventricular ejection fraction measured by ultrasound was an important predictor as regards life expectancy (EF 3550%: HR 3.74, IC 95% CI; 1.1112.65, P=0.034; EF<35%: HR 6.76, IC 95% CI; 1.8624.52, p=0.004). Conclusion. The life expectancy of elderly patients with untreated severe symptomatic aortic stenosis is very limited, with a high mortality during the first year. The ejection fraction is significantly associated with the prognosis in these patients(AU)
Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Aortic Valve Stenosis/complications , Aortic Valve Stenosis/diagnosis , Life Expectancy/trends , Stroke Volume , Stroke Volume/physiology , Risk Factors , Aortic Valve Stenosis/physiopathology , Aortic Valve Stenosis/surgery , Retrospective StudiesABSTRACT
INTRODUCTION: The natural outcome of untreated severe symptomatic aortic stenosis in the elderly patient is extremely poor. In this analysis we studied the clinical, ultrasound and analytical variables, that could be associated with the vital prognosis in this patient sub-group. MATERIAL AND METHODS: A retrospective study of patients admitted to our hospital between 2004 and 2008 due to symptoms associated with the presence of a severe aortic stenosis and were not considered for surgery. Demographic, concomitant diseases, ultrasound (ejection fraction, transvalvular gradient, valve area) and laboratory analytical data (haemoglobin, creatinine, atrial natriuretic peptide) were analysed and the logistic euroscore was calculated. RESULTS: A total of 49 patients were included (73.5% women), with a mean age of 82.2±5.5 years. The median follow up was 396.0 days, interquartile range 99.5-731.0 days, with a mortality of 75.5%. In the multivariate analysis, only the left ventricular ejection fraction measured by ultrasound was an important predictor as regards life expectancy (EF 35-50%: HR 3.74, IC 95% CI; 1.11-12.65, P=0.034; EF<35%: HR 6.76, IC 95% CI; 1.86-24.52, p=0.004). CONCLUSION: The life expectancy of elderly patients with untreated severe symptomatic aortic stenosis is very limited, with a high mortality during the first year. The ejection fraction is significantly associated with the prognosis in these patients.
Subject(s)
Aortic Valve Stenosis , Patient Admission , Refusal to Treat , Aged, 80 and over , Aortic Valve Stenosis/surgery , Female , Humans , Male , Retrospective Studies , Severity of Illness Index , Treatment OutcomeABSTRACT
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