From the Service de Cardiologie (A.L., M.B., D.B., H.L.B.), Service de Pharmacologie Clinique (E.O.), and Service de Chirurgie Thoracique et Cardiovasculaire (J.P.V., A.L.), CHU Rennes, Rennes, France; Département de Pharmacologie, Clinique et Expérimentale, Faculté de Médecine (E.O.) and LTSI (J.P.V., H.L.B.), Université de Rennes 1, Rennes, France; INSERM 0203, Centres d'Investigation Clinique, Rennes, France (E.O.); INSERM, U642, Rennes, France (J.P.V., H.L.B.); CHU Rouen, Hôpital Charles Nicolle, INSERM Unité 1096, Rouen, France (H.E.); CHU Bichat, Paris, France (B.I.); CHU Dupuytren, Limoges, France (M.L.); CHU Pitié-Salpêtrière, Paris, France (P.L.); and CHU Brest, Brest, France (M.G.).
Circ Cardiovasc Interv. 2014 Apr;7(2):240-7. doi: 10.1161/CIRCINTERVENTIONS.113.000482. Epub 2014 Feb 25.
Pulmonary hypertension (PH) is associated with poor prognosis in patients with severe aortic stenosis. The aim of this multicenter study was to describe clinical outcome after transcatheter aortic valve implantation.
The FRANCE 2 Registry included all patients undergoing transcatheter aortic valve implantation in France in 2010 and 2011. Patients were divided into 3 groups depending on systolic pulmonary artery pressure (sPAP) estimated in transthoracic echocardiography: group I, sPAP <40 mm Hg (no PH); group II, sPAP 40 to 59 mm Hg (mild-to-moderate PH); and group III, sPAP ≥60 mm Hg (severe PH). Patients were followed up for 1 year. A total of 2435 patients whose pre-transcatheter aortic valve implantation sPAP was reported were included. A total of 845 were in group I (34.7%), 1112 in group II (45.7%), and 478 in group III (19.6%). Procedural success, early complications, and 30-day mortality were statistically similar across sPAP groups. One-year mortality was higher in groups II and III (group I, 22%; group II, 28%; and group III, 28%; P=0.032). Mild-to-moderate and severe PH were identified as an independent factor of all-cause mortality. The major adverse cardiovascular event rates did not differ according to sPAP. New York Health Association functional class improved significantly in all groups.
PH (sPAP ≥40 mm Hg) in patients with aortic stenosis undergoing transcatheter aortic valve implantation was associated with increased 1-year mortality especially when severe (sPAP ≥60 mm Hg) but not with increased 30-day mortality, and functional status was significantly improved regardless of PAP level.
肺动脉高压（PH）与严重主动脉瓣狭窄患者的预后不良相关。这项多中心研究的目的是描述经导管主动脉瓣植入术后的临床结果。
FRANCE 2 注册研究纳入了 2010 年和 2011 年在法国接受经导管主动脉瓣植入术的所有患者。根据经胸超声心动图估计的收缩期肺动脉压（sPAP），患者分为 3 组：组 I，sPAP<40mmHg（无 PH）；组 II，sPAP 40 至 59mmHg（轻度至中度 PH）；组 III，sPAP≥60mmHg（重度 PH）。患者随访 1 年。共纳入 2435 例术前 sPAP 报告的患者。其中 845 例为组 I（34.7%），1112 例为组 II（45.7%），478 例为组 III（19.6%）。各组间手术成功率、早期并发症和 30 天死亡率无统计学差异。组 II 和组 III 的 1 年死亡率较高（组 I，22%；组 II，28%；组 III，28%；P=0.032）。轻度至中度和重度 PH 是全因死亡率的独立因素。根据 sPAP，主要不良心血管事件发生率无差异。所有组的纽约心功能协会（NYHA）功能分级均显著改善。
接受经导管主动脉瓣植入术的主动脉瓣狭窄患者的 PH（sPAP≥40mmHg）与 1 年死亡率增加相关，尤其是当严重 PH（sPAP≥60mmHg）时，但与 30 天死亡率增加无关，且无论 PAP 水平如何，功能状态均显著改善。
