经导管主动脉瓣植入术后脑栓塞与当代外科主动脉瓣置换术相比的后果：对健康相关生活质量的影响。
Consequence of cerebral embolism after transcatheter aortic valve implantation compared with contemporary surgical aortic valve replacement: effect on health-related quality of life.
作者信息
Uddin Akhlaque, Fairbairn Timothy A, Djoukhader Ibrahim K, Igra Mark, Kidambi Ananth, Motwani Manish, Herzog Bernhard, Ripley David P, Musa Tarique Al, Goddard Anthony J P, Blackman Daniel J, Plein Sven, Greenwood John P
机构信息
From the Multidisciplinary Cardiovascular Research Centre and Division of Cardiovascular and Diabetes Research, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom (A.U., T.A.F., A.K., M.M., B.H., D.P.R., T.A.M., S.P., J.P.G.); and Departments of Cardiology and Radiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, United Kingdom (I.K.D., M.I., A.J.P.G., D.J.B., S.P., J.P.G.).
出版信息
Circ Cardiovasc Interv. 2015 Mar;8(3):e001913. doi: 10.1161/CIRCINTERVENTIONS.114.001913.
BACKGROUND
Incidence of cerebral microinfarcts is higher after transcatheter aortic valve implantation (TAVI) compared with surgical aortic valve replacement (SAVR). It is unknown whether these lesions persist and what direct impact they have on health-related quality of life. The objective was to identify predictors of cerebral microinfarction and measure their effect on health-related quality of life during 6 months after TAVI when compared with SAVR.
METHODS AND RESULTS
Cerebral MRI was conducted at baseline, post procedure, and 6 months using diffusion-weighted imaging. Health-related quality of life was measured at baseline, 30 days, and 6 months with short form-12 health outcomes and EuroQol 5 dimensions questionnaires. One hundred eleven patients (TAVI, n=71; SAVR, n=40) were studied. The incidence (54 [77%] versus 17 [43%]; P=0.001) and number (3.4±4.9 versus 1.2±1.8; P=0.001) of new microinfarcts were greater after TAVI than after SAVR. The total volume per microinfarct was smaller in TAVI than in SAVR (0.23±0.24 versus 0.76±1.8 mL; P=0.04). The strongest associations for microinfarction were: TAVI (arch atheroma grade: r=0.46; P=0.0001) and SAVR (concomitant coronary artery bypass grafting: r=-0.33; P=0.03). Physical component score in TAVI increased after 30 days (32.1±6.6 versus 38.9±7.0; P<0.0001) and 6 months (40.4±9.3; P<0.0001); the improvement occurred later in SAVR (baseline: 34.9±10.6; 30 days: 35.9±10.2; 6 months: 42.8±11.2; P<0.001). After TAVI, there were no differences in the short form-12 health outcome scores according to the presence or size of new cerebral infarction.
CONCLUSIONS
Cerebral microinfarctions are more common after TAVI compared with SAVR but seem to have no negative effect on early (30 days) or medium term (6 months) health-related quality of life. Aortic atheroma (TAVI) and concomitant coronary artery bypass grafting (SAVR) are independent risk factors for cerebral microinfarction.
背景
与外科主动脉瓣置换术（SAVR）相比，经导管主动脉瓣植入术（TAVI）后脑微梗死的发生率更高。目前尚不清楚这些病变是否持续存在以及它们对健康相关生活质量有何直接影响。目的是确定TAVI后6个月内脑微梗死的预测因素，并与SAVR相比，测量它们对健康相关生活质量的影响。
方法和结果
在基线、术后及6个月时使用弥散加权成像进行脑部MRI检查。在基线、30天和6个月时，使用简短健康调查12项量表和欧洲五维度健康量表问卷测量健康相关生活质量。共研究了111例患者（TAVI组71例，SAVR组40例）。TAVI后新微梗死的发生率（54例[77%]对17例[43%]；P=0.001）和数量（3.4±4.9对1.2±1.8；P=0.001）均高于SAVR。TAVI组每个微梗死灶的总体积小于SAVR组（0.23±0.24对0.76±1.8 mL；P=0.04）。与微梗死最强的关联因素为：TAVI（主动脉弓粥样硬化分级：r=0.46；P=0.0001）和SAVR（同期冠状动脉搭桥术：r=-0.33；P=0.03）。TAVI组术后30天（32.1±6.6对38.9±7.0；P<0.0001）和6个月（40.4±9.3；P<0.0001）时身体成分评分升高；SAVR组改善出现较晚（基线：34.9±10.6；30天：35.9±10.2；6个月：42.8±11.2；P<0.001）。TAVI后，根据新脑梗死的存在与否或大小，简短健康调查12项量表评分无差异。
结论
与SAVR相比，TAVI后脑微梗死更常见，但似乎对早期（30天）或中期（6个月）健康相关生活质量无负面影响。主动脉粥样硬化（TAVI）和同期冠状动脉搭桥术（SAVR）是脑微梗死的独立危险因素。
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