经导管主动脉瓣植入术患者的慢性阻塞性肺疾病：临床结局、预后标志物和功能状态变化的见解。

Chronic obstructive pulmonary disease in patients undergoing transcatheter aortic valve implantation: insights on clinical outcomes, prognostic markers, and functional status changes.

机构信息

Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.

出版信息

JACC Cardiovasc Interv. 2013 Oct;6(10):1072-84. doi: 10.1016/j.jcin.2013.06.008.

DOI:10.1016/j.jcin.2013.06.008

PMID:24156967

Abstract

OBJECTIVES

This study sought to determine the effects of chronic obstructive pulmonary disease (COPD) on clinical outcomes in patients undergoing transcatheter aortic valve implantation (TAVI) and to determine the factors associated with worse outcomes in COPD patients.

BACKGROUND

No data exist on the factors determining poorer outcomes in COPD patients undergoing TAVI.

METHODS

A total of 319 consecutive patients (29.5% with COPD) who underwent TAVI were studied. Functional status was evaluated by New York Heart Association (NYHA) functional class, Duke Activity Status Index, and the 6-min walk test (6MWT) at baseline and at 6 to 12 months. The TAVI treatment was considered futile if the patient either died or did not improve in NYHA functional class at 6-month follow-up.

RESULTS

Survival rates at 1 year were 70.6% in COPD patients and 84.5% in patients without COPD (p = 0.008). COPD was an independent predictor of cumulative mortality after TAVI (hazard ratio: 1.84; 95% confidence interval: 1.08 to 3.13; p = 0.026). Improvement in functional status was observed after TAVI (p < 0.001 for NYHA functional class, Duke Activity Status Index, and 6MWT), but COPD patients exhibited less (p = 0.036) improvement in NYHA functional class. Among COPD patients, a shorter 6MWT distance predicted cumulative mortality (p = 0.013), whereas poorer baseline spirometry results (FEV1 [forced expiratory volume in the first second of expiration]) determined a higher rate of periprocedural pulmonary complications (p = 0.040). The TAVI treatment was futile in 40 COPD patients (42.5%) and a baseline 6MWT distance <170 m best determined the lack of benefit after TAVI (p = 0.002).

CONCLUSIONS

COPD was associated with a higher rate of mortality at mid-term follow-up. Among COPD patients, a higher degree of airway obstruction and a lower exercise capacity determined a higher risk of pulmonary complications and mortality, respectively. TAVI was futile in more than one-third of the COPD patients, and a shorter distance walked at the 6MWT predicted the lack of benefit after TAVI. These results may help to improve the clinical decision-making process in this challenging group of patients.

摘要

目的

本研究旨在探讨慢性阻塞性肺疾病（COPD）对经导管主动脉瓣置换术（TAVI）患者临床结局的影响，并确定与 COPD 患者预后不良相关的因素。

背景

目前尚无数据表明 COPD 患者 TAVI 术后预后不良的决定因素。

方法

共纳入 319 例连续患者（29.5%为 COPD 患者），均接受 TAVI 治疗。基线和 6-12 个月时采用纽约心脏协会（NYHA）心功能分级、杜克活动状态指数和 6 分钟步行试验（6MWT）评估患者的功能状态。如果患者在 6 个月随访时死亡或 NYHA 心功能分级无改善，则认为 TAVI 治疗无效。

结果

COPD 患者和无 COPD 患者的 1 年生存率分别为 70.6%和 84.5%（p = 0.008）。COPD 是 TAVI 后累积死亡率的独立预测因素（风险比：1.84；95%置信区间：1.08 至 3.13；p = 0.026）。TAVI 后患者的功能状态得到改善（NYHA 心功能分级、杜克活动状态指数和 6MWT 均 p < 0.001），但 COPD 患者的改善程度较低（p = 0.036）。在 COPD 患者中，6MWT 距离较短预示着累积死亡率（p = 0.013），而基线肺功能检查结果（FEV1 [第一秒用力呼气量]）较差则预示着围手术期肺部并发症发生率较高（p = 0.040）。40 例（42.5%）COPD 患者 TAVI 治疗无效，基线 6MWT 距离<170m 可最好地预测 TAVI 后无获益（p = 0.002）。