Eidet Jo, Dahle Gry, Bugge Jan Frederik, Bendz Bjørn, Rein Kjell Arne, Aaberge Lars, Offstad Jon Thomas, Fosse Erik, Aakhus Svend, Halvorsen Per Steinar
The Intervention Centre, Rikshospitalet, Oslo University Hospital, Oslo, Norway Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
Department of Cardiothoracic and Vascular Surgery, Oslo University Hospital, Oslo, Norway.
Interact Cardiovasc Thorac Surg. 2016 Jan;22(1):5-12. doi: 10.1093/icvts/ivv277. Epub 2015 Oct 13.
Left ventricular function is expected to improve after transcatheter aortic valve implantation due to the acute reduction in afterload, but does not occur in all patients. We hypothesized that the immediate intraoperative response in systolic left ventricular longitudinal motion during the procedure could be a predictor of short-term outcome.
Sixty-four patients treated with transcatheter aortic valve implantation for severe aortic stenosis were included. Transoesophageal 4- and 2-chamber echocardiograms were obtained immediately prior to and ∼15 min after valve implantation. Patients were defined as responders if their average left ventricular longitudinal peak systolic velocity increased by ≥20% from the preimplantation value and was related to the 3-month outcome.
Thirty-five patients were classified as responders, with an increase in the intraoperative longitudinal peak systolic velocity from an average of 2.2 ± 0.8 to 3.1 ± 1.1 cm/s (P < 0.001); the velocity was unchanged in the remaining 29 patients, who averaged 2.4 ± 1.1 cm/s. There were significantly fewer adverse cardiac events in the responder group at the 3-month follow-up (20 vs 45%, P = 0.03) and the New York Heart Association class was significantly better in the responders compared with non-responders. Responders had a significant reduction in N-terminal probrain natriuretic peptide levels [243 (113-361) vs 163 (64-273), P = 0.004] at the 3-month follow-up, whereas non-responders did not [469 (130-858) vs 289 (157-921), P = 0.48].
An immediate improvement in the longitudinal peak systolic velocity during the transcatheter aortic valve implantation procedure predicted a better short-term outcome and may be useful in identifying patients who are at risk of a less favourable outcome after transcatheter aortic valve implantation.
经导管主动脉瓣植入术后，由于后负荷急性降低，左心室功能预期会改善，但并非所有患者均如此。我们假设术中左心室收缩期纵向运动的即时反应可能是短期预后的一个预测指标。
纳入64例因严重主动脉瓣狭窄接受经导管主动脉瓣植入术的患者。在瓣膜植入术前及植入后约15分钟立即进行经食管四腔和两腔超声心动图检查。如果患者的平均左心室纵向收缩期峰值速度较植入前值增加≥20%，则定义为反应者，并将其与3个月的预后相关联。
35例患者被归类为反应者，术中纵向收缩期峰值速度从平均2.2±0.8 cm/s增加到3.1±1.1 cm/s（P<0.001）；其余29例患者的速度未改变，平均为2.4±1.1 cm/s。在3个月随访时，反应者组的不良心脏事件明显较少（20%对45%，P=0.03），与无反应者相比，反应者的纽约心脏协会心功能分级明显更好。在3个月随访时，反应者的N末端脑钠肽前体水平显著降低[243（113 - 361）对163（64 - 273），P = 0.004]，而无反应者则没有[469（130 - 858）对289（157 - 921），P = 0.48]。
经导管主动脉瓣植入术中纵向收缩期峰值速度的即时改善预示着更好的短期预后，可能有助于识别经导管主动脉瓣植入术后预后较差风险的患者。
