Annales de cardiologie et d'angeiologie最新文献_第7页

Effets de la pleine conscience (MBSR) sur la santé cardiométabolique: revue systématique et méta-analyse de 1200 participants 正念对心脏代谢健康的影响：1200名参与者的系统综述和荟萃分析

IF 0.3 Q4 Medicine

Annales de cardiologie et d'angeiologie

Pub Date : 2025-11-01 Epub Date: 2025-10-23 DOI: 10.1016/j.ancard.2025.101963

M. Temgoua , F. Teddy Endomba , C. Berenfeld , A. Berenfeld , J.G. Bloch

Contexte

La réduction du stress basée sur la pleine conscience (Mindfulness-Based Stress Reduction, MBSR) est proposée comme approche complémentaire pour améliorer les issues liées au stress et réduire le risque cardiovasculaire.

Méthodes

Nous avons réalisé une revue systématique et une méta-analyse pour évaluer l’impact de la stratégie MBSR sur la santé cardiométabolique. Les essais contrôlés évaluant les effets de la MBSR sur les facteurs de risque cardiométaboliques et les événements cliniques ont été inclus. Une recherche exhaustive a été menée dans les bases de données PubMed, EMBASE, Cochrane Library, Web of Science et PsycINFO. Le risque de biais a été évalué à l’aide de l’outil RoB2, et une méta-analyse à effets aléatoires a été réalisée. Le biais de publication a été examiné à l’aide du Funnel plot et du test d'Egger.

Résultats

Quatorze études (n ≈ 1 200 participants) ont été incluses. La stratégie MBSR était associée à des réductions significatives de l’hémoglobine glyquée (HbA1c), de la pression artérielle systolique, du stress perçu et des symptômes dépressifs. Le biais de publication était peu probable pour la majorité des critères évalués, et la certitude globale des preuves variait de faible à élevée (fig. 1 à 7).

Conclusion

Ces résultats suggèrent que la stratégie MBSR pourrait constituer une intervention complémentaire efficace pour réduire le risque cardiométabolique et améliorer le bien-être psychologique. Des essais randomisés de qualité supérieure sont nécessaires pour confirmer ces résultats.

基于正念的减压（MBSR）是一种改善压力相关结果和降低心血管风险的补充方法。方法我们进行了系统综述和荟萃分析，以评估MBSR策略对心脏代谢健康的影响。包括评估MBSR对心脏代谢风险因素和临床事件影响的对照试验。对PubMed、EMBASE、Cochrane Library、Web of Science和PsycINFO数据库进行了广泛的搜索。使用RoB2工具评估了偏差风险，并进行了随机效应荟萃分析。使用漏水图和Egger测试研究了出版方式。结果包括14项研究（n≈1200名参与者）。MBSR策略与糖化血红蛋白（HbA1c）、收缩压、感知压力和抑郁症状的显著降低有关。在大多数评估标准中，发表偏倚是不太可能的，证据的总体确定性从低到高（图1 - 7）。结论：这些结果表明，MBSR策略可能是一种有效的补充干预措施，以降低心脏代谢风险和改善心理健康。需要高质量的随机试验来证实这些结果。

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引用次数: 0

Tachycardie de Gallavardin syncopale détectée sur un moniteur implantable chez une patiente âgée : prise en charge ablative 一名老年患者在植入监视器上发现的加拉瓦丁心动过速：消融治疗

IF 0.3 Q4 Medicine

Annales de cardiologie et d'angeiologie

Pub Date : 2025-11-01 Epub Date: 2025-09-20 DOI: 10.1016/j.ancard.2025.101930

P.-Y. Tarlet, F. Elmkies, P. Lachambre, T. Zerah, J. Clerc, P. Meimoun

We report the case of a 75-year-old female patient who was evaluated for an exertional syncope, revealing an infundibular ventricular tachycardia. The diagnosis was made possible by the implantation of a loop recorder, which detected frequent episodes of non-sustained ventricular tachycardia. Radiofrequency ablation guided by a three-dimensional mapping system led to the complete suppression of the arrhythmias. This case highlights the value of implantable monitoring tools in the etiological diagnosis of syncope, the importance of obtaining a 12-lead ECG during the arrhythmia to determine its origin, and the role of three-dimensional mapping systems in the diagnosis and treatment of idiopathic ventricular arrhythmias.

我们报告的情况下，一个75岁的女性患者谁是评估一个运动性晕厥，揭示了室性心动过速。通过植入循环记录仪，可以检测到非持续性室性心动过速的频繁发作，从而使诊断成为可能。三维定位系统引导下的射频消融可完全抑制心律失常。本病例强调了植入式监测工具在晕厥病因诊断中的价值，在心律失常期间获得12导联心电图以确定其起源的重要性，以及三维制图系统在特发性室性心律失常诊断和治疗中的作用。

引用次数: 0

Profil clinique, échocardiographique, prise en charge et pronostic des thrombi intraventriculaire gauches : étude rétrospective analytique 左室内血栓形成的临床概况、超声心动图、治疗和预后：回顾性研究

IF 0.3 Q4 Medicine

Annales de cardiologie et d'angeiologie

Pub Date : 2025-11-01 Epub Date: 2025-09-20 DOI: 10.1016/j.ancard.2025.101938

Taryètba Andre Arthur Seghda , Abou Coulibaly , Martin Wendlassida Nacanabo , Djeme Claudine Dah , Mireille Abouga Loya , Laurence Flork , Anna Tall Thiam , Nobila Valentin Yaméogo , André K Samadoulougou , Patrice Zabsonre

Introduction/objective

To analyze the clinical and echocardiographic features, as well as the prognosis of patients hospitalized for left ventricular thrombi.

Materials and Methods

This retrospective cross-sectional study was conducted in the Cardiology Department of the Bogodogo University Hospital Center. The study period, which extended from January 1, 2017, to October 31, 2023, aimed to achieve both descriptive and analytical objectives. The study population consisted of all hospitalized patients diagnosed with left ventricular thrombi, regardless of the underlying cardiac pathology. Data collection focused on clinical characteristics, echocardiographic parameters, and in-hospital mortality outcomes.

Results

Sixty-five patients were included. Underlying heart conditions were mostly cardiomyopathies: Ischemic, idiopathic, and peripartum. Thrombi were considered high embolic risk in 49.2% of cases. In-hospital mortality was 23%. The mobility or floating nature of the thrombi did not influence mortality. Factors associated with in-hospital death were dyspnea of at least stage 3 and cardiogenic shock.

Conclusion

Left ventricular thrombi are common to ischemic, idiopathic, and peripartum cardiomyopathy. They don’t increase in-hospital but do increase morbidity.

前言/目的分析左室血栓住院患者的临床、超声心动图特点及预后。材料和方法本回顾性横断面研究在波哥大大学医院中心心脏科进行。研究期间从2017年1月1日延长至2023年10月31日，旨在实现描述性和分析性目标。研究人群包括所有诊断为左心室血栓的住院患者，无论其潜在的心脏病理如何。数据收集的重点是临床特征、超声心动图参数和住院死亡率结果。结果共纳入65例患者。潜在的心脏疾病主要是心肌病：缺血性、特发性和围产期。49.2%的病例认为血栓是高栓塞风险。住院死亡率为23%。血栓的流动性或漂浮性不影响死亡率。与院内死亡相关的因素是3期以上呼吸困难和心源性休克。结论左室血栓在缺血性、特发性和围生期心肌病中常见。它们不会增加住院人数，但会增加发病率。

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引用次数: 0

TAVI en centres non chirurgicaux : entre pragmatisme clinique et mirage réglementaire 非手术中心的TAVI：从临床实用主义到监管海市蜃楼

IF 0.3 Q4 Medicine

Annales de cardiologie et d'angeiologie

Pub Date : 2025-11-01 Epub Date: 2025-08-20 DOI: 10.1016/j.ancard.2025.101915

Radwan Hakim, Franck Albert

TAVI has emerged as a safe and effective alternative to surgical aortic valve replacement, including in low-risk patients. However, French regulations still require the procedure to be performed exclusively in centers with on-site cardiac surgery. While historically justified, this requirement now appears outdated in light of technical advancements, reduced complication rates, and reassuring registry data. Several countries have already demonstrated the feasibility and safety of TAVI in experienced non-surgical centers. The current restriction generates inequalities in access, longer waiting times, and loss of patient opportunity. A structured evolution of the model, based on experience, quality criteria, and organized collaborations, could broaden access to TAVI without compromising safety. It is time to reconcile safety, pragmatism, and equitable access.

TAVI已成为外科主动脉瓣置换术安全有效的替代方法，包括在低风险患者中。然而，法国法规仍然要求该手术只能在有现场心脏手术的中心进行。虽然历史上是合理的，但鉴于技术的进步、降低的并发症率和可靠的注册表数据，这一要求现在似乎已经过时了。一些国家已经在有经验的非手术中心证明了TAVI的可行性和安全性。目前的限制造成了获取方面的不平等、更长的等待时间和患者机会的丧失。基于经验、质量标准和有组织的合作，对该模型进行结构化的改进，可以在不影响安全性的情况下扩大TAVI的获取。现在是协调安全、实用主义和公平获取的时候了。

引用次数: 0

Fibrillation atriale révélatrice d’un hyperaldostéronisme primaire : à propos d’un cas 原发性醛固酮升高的房颤：关于一个病例

IF 0.3 Q4 Medicine

Annales de cardiologie et d'angeiologie

Pub Date : 2025-11-01 Epub Date: 2025-09-24 DOI: 10.1016/j.ancard.2025.101952

Hind Hibatouallah , Mohamed Mehdi Guedira , Selma Siagh , Asmae Benssied , Youssef Fihri , Zouhair Lakhal , Aatif Benyass

<div><div>Primary hyperaldosteronism is the most common cause of secondary hypertension, with a prevalence estimated between 5% and 15%. Despite this, it remains largely underdiagnosed due to often non-specific clinical manifestations and insufficient screening. However, primary hyperaldosteronism is associated with significantly higher cardiovascular morbidity and mortality compared to essential hypertension, regardless of blood pressure levels and usual cardiac remodeling. Recent studies have highlighted a direct link between primary hyperaldosteronism and atrial fibrillation—the most common sustained arrhythmia in adults—associated with increased cardiovascular risk. This connection is partly explained by the direct involvement of the renin-angiotensin-aldosterone system in the pathophysiology of this arrhythmia.</div><div>We report the case of a patient with moderate hypertension, persistent hypokalemia, and unexplained atrial fibrillation. The absence of hemodynamic impact on echocardiography and the exclusion of classical etiologies of atrial fibrillation led to the suspicion of primary hyperaldosteronism. Hormonal testing confirmed the diagnosis of primary hyperaldosteronism due to a Conn's adenoma. A laparoscopic adrenalectomy was performed, with favorable outcomes.</div><div>This case highlights the often underestimated association between primary hyperaldosteronism and atrial fibrillation, and emphasizes the importance of targeted screening in hypertensive patients with unexplained atrial fibrillation, to optimize management and improve cardiovascular prognosis.</div></div><div><div>L’hyperaldostéronisme primaire est la cause la plus fréquente d’hypertension artérielle secondaire, avec une prévalence estimée entre 5 et 15 %. Malgré cela, il reste largement sous-diagnostiqué, en raison de manifestations cliniques souvent peu spécifiques et d’un dépistage encore insuffisant. Cependant, l’hyperaldostéronisme primaire est associé à une morbidité et une mortalité cardiovasculaires significativement plus élevées que l’hypertension artérielle essentielle, indépendamment des chiffres tensionnels et des remaniements cardiaques habituels. Des études récentes ont mis en évidence un lien direct entre l’ hyperaldostéronisme primaire et la fibrillation atriale, principale arythmie soutenue de l’adulte, associée à une augmentation du risque cardiovasculaire. Ceci s’explique notamment par l’implication directe du système rénine-angiotensine-aldostérone dans la physiopathologie de cette arythmie.</div><div>Nous rapportons le cas d’un patient présentant une hypertension artérielle modérée, une hypokaliémie persistante et une fibrillation atriale inexpliquée. L’absence de retentissement hémodynamique à l’échocardiographie, ainsi que l’exclusion des étiologies classiques de la fibrillation atriale, ont conduit à suspecter un hyperaldostéronisme primaire. Le bilan hormonal a confirmé le diagnostic d’ hyperaldostéronisme primaire en rapport avec un adénome d

原发性高醛固酮增多症是继发性高血压最常见的原因，患病率估计在5%至15%之间。尽管如此，由于非特异性临床表现和筛查不足，该病在很大程度上仍未得到充分诊断。然而，与原发性高血压相比，原发性高醛固酮增多症的心血管发病率和死亡率明显更高，无论血压水平和通常的心脏重构如何。最近的研究强调了原发性高醛固酮增多症和房颤之间的直接联系，房颤是成人中最常见的持续性心律失常，与心血管风险增加有关。肾素-血管紧张素-醛固酮系统直接参与这种心律失常的病理生理，部分解释了这种联系。我们报告的病例患者中度高血压，持续低钾血症，和不明原因的心房颤动。超声心动图没有血流动力学影响，排除房颤的经典病因，导致怀疑原发性高醛固酮增多症。激素检查证实原发性醛固酮增多症是由Conn腺瘤引起的。行腹腔镜肾上腺切除术，效果良好。本病例强调了原发性高醛固酮增多症与房颤之间常被低估的相关性，并强调了对伴有不明原因房颤的高血压患者进行针对性筛查的重要性，以优化管理，改善心血管预后。原发性高血压病与原发性高血压病合并为原发性高血压病和继发性高血压病合并为原发性高血压病，平均为原发性高血压病和原发性高血压病合并为原发性高血压病。malgraise，将停止大规模的诊断，在临床表现上的理由是，没有充分的证据表明，没有充分的证据表明，没有充分的证据表明，没有充分的证据。因此，高胆固醇与主要的心血管疾病相关，如发病率、死亡率、心血管疾病的显著性，以及高血压与基本的心血管疾病相关，如高血压、高血压和心血管疾病相关。该组织的主要研究对象是成年患者，主要研究对象是成年患者，主要研究对象是成年患者，主要研究对象是成年患者。杜塞西解释尤其是par l 'implication流转systeme renine-angiotensine-aldosterone在physiopathologie de这个arythmie。目前的病例包括：1例患者患有高血压，1例患者患有高血压，1例患者患有高血压，1例患者患有高血压，1例患者患有高血压，1例患者患有高血压，1例患者患有高血压，1例患者患有高血压，1例患者患有高血压，1例患者患有高血压，1例患者患有高血压，1例患者患有慢性高血压，1例患者患有心房纤颤，1例患者患有不明原因的高血压。没有保留的情况下，有的的的，的：的，不排除的，的，不排除的，的，不排除的。Le bilan贺尔蒙证实，Le Le诊断为高变性者，原发于高变性者，原发于高变性者，原发于高变性者，原发于高变性者，原发于高变性者，原发于高变性者。研究结果表明：高血压患者与高血压患者相比，高血压患者与高血压患者相比，高血压患者与高血压患者相比，高血压患者与高血压患者相比，高血压患者与高血压患者相比，高血压患者与慢性心血管患者相比，高血压患者与高血压患者相比，高血压患者与高血压患者相比，高血压患者与高血压患者相比，高血压患者与高血压患者相比，高血压患者与慢性心血管患者相比，高血压患者与高血压患者相比，高血压患者与高血压患者相比，高血压患者与高血压患者相比。

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引用次数: 0

Thrombus enclavé dans le foramen ovale perméable : à propos d’un cas révélé par une embolie pulmonaire au CHU de Libreville 可渗透的椭圆形孔内的血栓：关于利伯维尔医院肺栓塞的一个病例

IF 0.3 Q4 Medicine

Annales de cardiologie et d'angeiologie

Pub Date : 2025-11-01 Epub Date: 2025-09-20 DOI: 10.1016/j.ancard.2025.101936

Christelle P Akagha Konde , Mahutondji Christian Allognon , Elsa Ayo Bivigou , Francis Ndoume Obiang , Jean Léonard Mbini Junior , Arthur Matsanga , Ervais Richard Obame

The patent foramen ovale is common in the general population. It is often encountered during paradoxical embolisms. During a pulmonary embolism, its presence is a poor prognosis. The discovery of an enclosed thrombus in this area is rare. We report a case of an enclaved thrombus in the patent foramen ovale discovered during a transthoracic echocardiography indicated in the presence of a suspected pulmonary embolism in a pregnant woman. This patient presented with hemodynamic instability, the evolution of which was favorable after thrombolysis with tenecteplase. In the absence of consensus on the management of thrombi trapped in the patent foramen ovale, the track of a better prognosis according to the class of thrombolytics used should be studied.

卵圆孔未闭在普通人群中很常见。这是经常遇到的矛盾栓塞。在肺栓塞时，它的存在预后很差。在此区域发现封闭血栓是罕见的。我们报告一例包膜血栓在未闭的卵圆孔发现在经胸超声心动图表明在一个怀疑肺栓塞的孕妇。该患者表现为血流动力学不稳定，在用替尼替普酶溶栓后，血流动力学的发展是有利的。在对卵圆孔未闭内血栓的处理缺乏共识的情况下，应根据所使用的溶栓药物的种类来研究更好的预后。

引用次数: 0

Syndrome d'apnée obstructive du sommeil et fibrillation atriale - mécanismes, diagnostic et traitement 阻塞性睡眠呼吸暂停和房颤-机制、诊断和治疗

IF 0.3 Q4 Medicine

Annales de cardiologie et d'angeiologie

Pub Date : 2025-11-01 Epub Date: 2025-09-20 DOI: 10.1016/j.ancard.2025.101932

Hoang T. Kien , Amara Walid , Alloujami Mazen , Jochmans Sébastien , Moini Cyrus

Obstructive sleep apnea syndrome is characterized by repeated airway obstructions leading to intermittent hypoxia and sleep fragmentation. It is a major independent risk factor for atrial fibrillation, with a high prevalence of obstructive sleep apnea among patients with atrial fibrillation. The pathophysiological mechanisms include intermittent hypoxia causing sympathetic activation and atrial remodeling, as well as negative intrathoracic pressure fluctuations that promote arrhythmia. Diagnosis relies on polysomnography and standardized tools such as the SCOPER system. Continuous positive airway pressure is the standard treatment and has shown beneficial effects on atrial fibrillation progression and recurrence, although study results vary. Integrated management of obstructive sleep apnea and atrial fibrillation, including weight control, is essential to optimize clinical outcomes. Further research is needed to better identify patient subgroups and evaluate different therapeutic options.

阻塞性睡眠呼吸暂停综合征的特点是反复气道阻塞导致间歇性缺氧和睡眠破碎。它是心房颤动的主要独立危险因素，心房颤动患者中阻塞性睡眠呼吸暂停的患病率很高。其病理生理机制包括间歇性缺氧引起交感神经激活和心房重构，以及胸内负压波动促进心律失常。诊断依赖于多导睡眠图和标准工具，如SCOPER系统。持续气道正压通气是标准的治疗方法，对房颤的进展和复发有有益的效果，尽管研究结果各不相同。阻塞性睡眠呼吸暂停和心房颤动的综合管理，包括体重控制，对优化临床结果至关重要。需要进一步的研究来更好地确定患者亚组并评估不同的治疗方案。

引用次数: 0

Profil étiologique et pronostic de l’insuffisance cardiaque du sujet jeune dans un pays à ressources limitées 资源有限国家年轻人心力衰竭的病因和预后

IF 0.3 Q4 Medicine

Annales de cardiologie et d'angeiologie

Pub Date : 2025-11-01 Epub Date: 2025-09-20 DOI: 10.1016/j.ancard.2025.101935

Anna Thiam , Jules Ramdé , Georges RC Millogo , Larissa J. Kagambega , Jonas K. Kologo , Laurence Benon , Elisé Kabore , Valentin N. Yameogo , André K. Samadoulougou , Patrice Zabsonre

Objectives

To study the etiological factors and prognosis of heart failure in subjects aged 15 to 45 in the cardiology department of the Yalgado Ouédraogo University Hospital Center.

Methodology

It was a retrospective cohort study from March 1, 2020, to February 28, 2022, involving 130 patients.

Results

The average age of our patients was 30 ±7,88 years, with a female predominance of 57,7 %. Sedentary lifestyle was the most found cardiovascular risk factor in 49,2 % of cases, followed by hypertension in 25,2%. Congestive heart failure was the most frequent clinical presentation in our total sample (79%). Rheumatic valvulopathies were the most common aetiology in 27,6 % followed by peripartum cardiomyopathy in 23,8 %. On the electrocardiogram, arrhythmias were found in 27,5 % of patients; they were dominated by atrial arrhythmias (33,3% of arrhythmias). The left ventricular ejection fraction was reduced in 53,85% of cases. One-year Mortality was 9,2 %. In a post-hospital survey, 65 patients were not coming back. Among the monitored patients, 11 were deceased. The factors linked to the deaths were the existence of comorbidities and rehospitalizations.

Conclusion

Aetiologies are always dominated by valvulopathies. However, the peripartum cardiomyopathy is often found in our context. The prognosis can be improved by more appropriate management, like cardiac surgery for valvulopathies and prevention for peripartum cardiomyopathy.

目的探讨亚尔加多大学附属医院中心心内科15 ~ 45岁患者心力衰竭的病因及预后。方法回顾性队列研究，时间为2020年3月1日至2022年2月28日，共纳入130例患者。结果本组患者平均年龄30±7.88岁，女性占57.7%。久坐不动的生活方式是最常见的心血管危险因素，占49.2%，其次是高血压，占25.2%。在我们的总样本中，充血性心力衰竭是最常见的临床表现（79%）。风湿性心瓣膜病是最常见的病因，占27.6%，其次是围产期心肌病，占23.8%。在心电图上，心律失常发生率为27.5%；其中以房性心律失常为主（33.3%）。在53.85%的病例中左心室射血分数降低。一年死亡率为9.2%。在一次出院后的调查中，65名患者没有再回来。在受监测的患者中，有11人死亡。与死亡相关的因素是合并症的存在和再住院。结论病因以瓣膜病为主。然而，围产期心肌病却经常出现在我们的语境中。通过适当的治疗，如心脏手术治疗瓣膜病和预防围产期心肌病，可改善预后。

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引用次数: 0

Stimulation de l’aire de la branche gauche et resynchronisation dans l’insuffisance cardiaque 心力衰竭患者左束支区起搏与再同步。

IF 0.3 Q4 Medicine

Annales de cardiologie et d'angeiologie

Pub Date : 2025-11-01 Epub Date: 2025-09-29 DOI: 10.1016/j.ancard.2025.101955

Jérôme Taieb , Walid Amara

Left bundle branch block pacing (LBBAP) is a recent technique for capturing conduction pathways to allow physiological ventricular activation.

It is technically more reliable than Hisian pacing and can correct proximal left bundle branch block. In this context, numerous registries and the first small randomized studies have evaluated the benefit of left bundle branch block pacing compared to conventional resynchronization therapy, with encouraging results in favor of LBBAP. More robust randomized studies are underway. A consensus document has included this strategy as a possible first-line option and is recommended in cases of failure of conventional resynchronization therapy. Manufacturers are developing dedicated equipment with LBBAP pacing integrated into the defibrillation lead.

左束分支阻滞起搏（LBBAP）是一种捕获传导通路以实现生理心室激活的新技术。技术上比希氏起搏更可靠，能纠正左束近端支阻滞。在此背景下，许多注册研究和首批小型随机研究评估了左束分支阻滞起搏与传统再同步化治疗相比的益处，结果表明LBBAP更有利。更多可靠的随机研究正在进行中。一份共识文件已将该策略作为可能的一线选择，并建议在常规再同步治疗失败的情况下使用。制造商正在开发将LBBAP起搏集成到除颤导联中的专用设备。

引用次数: 0

Évolution de la prise en charge du rétrécissement aortique serré au centre hospitalier départemental de La Roche-sur-Yon, Vendée (2005, 2015 et 2022). Vendee（2005年、2015年和2022年），La Roche-sur-Yon省医院中心主动脉狭窄治疗的演变。

IF 0.3 Q4 Medicine

Annales de cardiologie et d'angeiologie

Pub Date : 2025-11-01 Epub Date: 2025-09-25 DOI: 10.1016/j.ancard.2025.101954

Marine Perion , Jacques Chan Peng , Louen Ropers , Jérôme Dimet , Emmanuel Boiffard , Olivier Baron , Thibaut Manigold , Jean-Christian Roussel , Patrice Guérin , Hervé Pouliquen

Background

Severe calcific aortic stenosis (AS) is the most common valvular heart disease in the elderly and carries a poor prognosis without intervention. The introduction of transcatheter aortic valve implantation (TAVI) in 2002 profoundly reshaped therapeutic strategies. This study aimed to evaluate changes in patient management and outcomes at the Departmental Hospital Center of La Roche‑sur‑Yon over three time periods: 2005 (pre‑TAVI era), 2015 (early TAVI integration), and 2022 (TAVI‑dominant era).

Methods

We conducted a retrospective, single-center observational study including all patients hospitalized for symptomatic severe AS or reduced left ventricular ejection fraction. Clinical characteristics, operative risk scores, management strategies, and one-year outcomes were analyzed.

Results

Between 2005 and 2022, the number of patients managed for SAS increased by 158% (65 in 2005, 136 in 2015, 168 in 2022). Mean age (79 years in 2022) and male proportion (60%) remained stable. Therapeutic strategies shifted markedly (p < 0.001): surgery predominated in 2005 (67%), whereas TAVI became the most frequent treatment in 2022 (55%), followed by surgery (21%) and medical therapy (24%). Surgically treated patients were increasingly selected, with a median EuroSCORE II falling from 3,95 % (2005) to 1.1% (2022). One-year all-cause mortality in 2022 was 0% after surgery, 5.9% after TAVI (down from 28.8% in 2015, p = 0.008), and 68% with medical therapy (p < 0.001). Heart failure rehospitalizations were also more frequent in the medical group (33% vs 6% after TAVI and 2% after surgery; p = 0.016). The proportion of patients not presented at the heart team meeting declined significantly (17% in 2022 vs 35% before 2015; p < 0.001). The waiting times nevertheless remained significant (median of 70 days between admission and the MDT meeting, plus 41 days before the procedure).

Conclusions

Integration of TAVI has profoundly transformed AS management in our center, now the dominant strategy with significantly improved one-year prognosis. Medically treated patients still experience poor outcomes, underscoring the need to reduce delays and streamline the care pathway.

重度钙化性主动脉瓣狭窄（AS）是老年人最常见的瓣膜性心脏病，未经干预预后较差。2002年引入的经导管主动脉瓣植入术（TAVI）深刻地重塑了治疗策略。本研究旨在评估La Roche - sur - Yon部门医院中心在三个时间段内患者管理和结果的变化：2005年（前TAVI时代），2015年（早期TAVI整合）和2022年（TAVI主导时代）。方法我们进行了一项回顾性、单中心观察性研究，纳入了所有因症状性严重AS或左室射血分数降低而住院的患者。分析临床特征、手术风险评分、管理策略和一年的结果。结果2005年至2022年，接受SAS治疗的患者数量增加了158%（2005年65人，2015年136人，2022年168人）。平均年龄（2022年79岁）和男性比例（60%）保持稳定。治疗策略发生了显著变化（p < 0.001）：手术在2005年占主导地位（67%），而TAVI在2022年成为最常见的治疗方法（55%），其次是手术（21%）和药物治疗（24%）。手术治疗的患者越来越多地被选择，中位EuroSCORE II从3.95%（2005年）下降到1.1%（2022年）。2022年手术后一年全因死亡率为0%，TAVI后为5.9%（低于2015年的28.8%,p = 0.008），药物治疗后为68% （p < 0.001）。内科组的心力衰竭再住院率也更高（33% vs TAVI后的6%，手术后的2%；p = 0.016）。未出席心脏小组会议的患者比例显著下降（2022年为17%，2015年为35%；p < 0.001）。然而，等待时间仍然很长（从入院到MDT会议的中位数为70天，加上手术前41天）。结论TAVI的整合已经深刻地改变了我中心AS的管理，现在是主导策略，显著改善了1年预后。接受过医疗治疗的患者的预后仍然很差，这凸显了减少延误和简化护理途径的必要性。

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