Halkin Amir, Steinvil Arie, Aviram Galit, Biner Simon, Banai Shmuel, Keren Gad, Finkelstein Ariel, Topilsky Yan
Department of Cardiology, Tel Aviv Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Department of Radiology, Tel Aviv Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Catheter Cardiovasc Interv. 2016 May;87(6):1156-63. doi: 10.1002/ccd.26298. Epub 2015 Nov 3.
To investigate the impact of preprocedural left ventricular (LV) diastolic function on outcomes of patients with postprocedural aortic regurgitation (ARpost ) following transcatheter aortic valve replacement (TAVR).
The predictors and mechanisms of the increased mortality in patients with ARpost are inadequately defined.
Baseline clinical and echocardiographic variables from a prospective TAVR registry were analyzed. Preprocedural correlates of late outcomes (all-cause mortality and the composite of mortality, stroke, heart failure, and new-onset atrial fibrillation) were examined according to the presence and severity of ARpost .
Of the 418 patients undergoing TAVR, ARpost was present in 212 (51%): mild 36%, moderate-severe 15%. Mean follow-up was 909 ± 489 days. All-cause mortality and composite endpoint rates were significantly increased in patients with moderate-severe ARpost compared with patients with either none or only mild ARpost (38, 22, 21%, P = 0.02; and, 56, 35, 40%, P = 0.01; respectively). Moderate-severe (though not mild) ARpost was independently associated with mortality and the composite endpoint (HR = 1.93 [95%CI 1.15-3.14], P = 0.01; HR = 1.85 [95%CI 1.22-2.77], P = 0.004], respectively). By multivariate analysis, preprocedural LV deceleration time (DT) < 160 ms was independently associated with the risk of all-cause mortality and the composite endpoint among patients with mild AR (HR = 1.74 [95%CI 1.14-2.60], P = 0.01; and, HR = 1.73 [95%CI 1.23-2.41], P = 0.002, respectively) and moderate-severe ARpost (HR = 1.81 [95%CI 1.28-2.51], P < 0.001; HR = 1.86 [95%CI 0.22-2.80], P = 0.004, respectively).
Preprocedural impairment of LV filling, reflected by short DT, portends an adverse prognosis in TAVR patients who develop ARpost independently of other clinical and echocardiocardigraphic measures including AS severity and systolic LV function. © 2015 Wiley Periodicals, Inc.
研究经导管主动脉瓣置换术（TAVR）前左心室（LV）舒张功能对术后主动脉瓣反流（ARpost）患者预后的影响。
ARpost患者死亡率增加的预测因素和机制尚未明确。
分析前瞻性TAVR注册研究的基线临床和超声心动图变量。根据ARpost的存在情况和严重程度，研究晚期预后（全因死亡率以及死亡率、中风、心力衰竭和新发房颤的复合终点）的术前相关因素。
在418例行TAVR的患者中，212例（51%）存在ARpost：轻度36%，中重度15%。平均随访时间为909±489天。与无ARpost或仅有轻度ARpost的患者相比，中重度ARpost患者的全因死亡率和复合终点发生率显著升高（分别为38%、22%、21%，P = 0.02；以及56%、35%、40%，P = 0.01）。中重度（而非轻度）ARpost与死亡率和复合终点独立相关（HR = 1.93[95%CI 1.15 - 3.14]，P = 0.01；HR = 1.85[95%CI 1.22 - 2.77]，P = 0.004）。多因素分析显示，术前LV减速时间（DT）<160 ms与轻度AR（HR = 1.74[95%CI 1.14 - 2.60]，P = 0.01；以及HR = 1.73[95%CI 1.23 - 2.41]，P = 0.002）和中重度ARpost患者的全因死亡风险和复合终点独立相关（分别为HR = 1.81[95%CI 1.28 - 2.51]，P < 0.001；HR = 1.86[95%CI 0.22 - 2.80]，P = 0.004）。
术前LV充盈受损以短DT为表现，预示着发生ARpost的TAVR患者预后不良，且独立于其他临床和超声心动图指标，包括主动脉瓣狭窄严重程度和LV收缩功能。©2015威利期刊公司。
