老年人心脏瓣膜病

Authors:

• Dania Mohty, MD, PhD

• Maurice Enriquez-Sarano, MD

• Sorin Pislaru, MD, PhD

Section Editors:

• Catherine M Otto, MD

• Kenneth E Schmader, MD

Deputy Editor:

• Susan B Yeon, MD, JD, FACC

翻译:

• 周文武, 主任医师

引言

老年人心脏瓣膜病的诊断和治疗受到了自20世纪后半期开始期望寿命显著延长的影响。例如，在美国，80岁及以上的人群数目预计从1990年的690万将增加到2050年的2500万左右[1]。因此，退行性心脏瓣膜病很可能成为一种日益增多的问题。此外，瓣膜疾病的患病率随衰老而增加，75岁及以上的人群中每8人中超过1人有中度或重度心脏瓣膜病[2]。

幸运的是，随着心脏手术的重大进步，过去可能不适合手术的老年患者现在也可考虑手术治疗。对于手术和围手术期幸存的患者，功能水平和生活质量以及(在某些研究中)生存率与年龄匹配的一般人群受试者相似[3-5]。因此，只能对一般状况极佳的老年患者考虑手术这一经典观念受到了挑战，因为在共存疾病不严重或若不受控制也不会有严重影响的患者中取得了较高的手术成功率[6]。而且，经皮瓣膜介入技术的出现将进一步增加老年患者的治疗选择。事实上，经导管主动脉瓣置换术(transcatheter aortic valve replacement, TAVR)的成功促进了二尖瓣及三尖瓣疾病处理的积极发展[7,8]。 (参见“症状性重度主动脉瓣狭窄的治疗选择”)

研究使用了不同的年龄标准来界定老年人。虽然目前尚无关于心脏瓣膜病患病率的综合人群数据，但有几项研究提供了显著心脏瓣膜病(根据年龄分层)患病率的重要信息(表 1)。老年人最常见的心脏瓣膜病有主动脉瓣狭窄(aortic stenosis, AS)、器质性和缺血性(功能性)二尖瓣反流以及三尖瓣反流。

主动脉瓣狭窄

钙化性或退行性主动脉瓣疾病被认为是老年患者中最常见的瓣膜病变[9-11]。在赫尔辛基老化研究中，501例随机选择的75-86岁男性和女性进行了放射影像学检查和多普勒超声心动图检查[10,11]。至少为中度AS[定义为主动脉瓣口面积(aortic valve area, AVA)≤1.2cm²且跨瓣速度比≤0.35]的患病率为5%；重度AS(AVA≤0.8cm²且跨瓣速度比≤0.25)的患病率随年龄增加而增加，从75-76岁人群的1%-2%增至86岁人群的近6%[11]。女性中更常发生中度或重度AS(8.8% vs 男性中的3.6%)[10]。 (参见“主动脉瓣狭窄的瓣口面积”)

在转诊中心及疗养院人群中也报道了类似的患病率，在90岁以上人群中患病率甚至更高[12,13]。

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