Weissler-Snir Adaya, Shapira Yaron, Sagie Alexander, Kazum Shirit, Assali Abid, Vaknin-Assa Hana, Bental Tamir, Codner Pablo, Orvin Katia, Kornowski Ran, Vaturi Mordehay
J Heart Valve Dis. 2015 May;24(3):272-9.
The dynamics of left ventricular mass (LVM) regression following the relief of chronic left ventricular pressure overload are prone to variation. The study aim was to identify determinants of LVM regression following transcatheter aortic valve implantation (TAVI).
A total of 134 patients undergoing TAVI was identified. A retrospective analysis was performed of LVM indexed to body surface area (LVMi), calculated using transthoracic echocardiography at baseline and at six to 12 months post-TAVI.
At six to 12 months after TAVI, there was a significant reduction in mean LVMi (from 118.2 ± 26.67 g/m2 to 103.4 ± 27.07 g/m2; p < 0.001) driven by a decrease in left ventricular wall thickness. The relative wall thickness (RWT) was decreased (0.54 ± 0.10 cm versus 0.51 ± 0.09 cm; p = 0.006), whereas the prevalence of concentric remodeling (RWT ≥ 0.42) remained unchanged (85.1% versus 80.6%; p = 0.3). However, 47 patients (35.1%) demonstrated significant LVMi regression, but had a lower baseline LVMi than patients who demonstrated significant regression (109.8 ± 25.8 g/m2 versus 122 ± 26.1 g/m2; p = 0.008) but had otherwise similar characteristics. A greater magnitude of LVMi reduction was associated with a greater baseline LVMi (r = 0.39; p < 0.001), where patients with LVMi in the highest quartile had the most substantial reduction in LVMi (p < 0.001). Multivariable analysis identified pre-TAVI LVMi as the sole independent predictor of LVMi regression at six to 12 months post-TAVI (P = 0.45; 95% confidence interval 0.255-0.534; p < 0.001).
LVM regression at six to months post-TAVI was variable, with about one-third of patients not showing a significant regression. Only baseline LVM predicted LVM regression; patients with a higher baseline LVM demonstrated a greater regression.
慢性左心室压力超负荷缓解后左心室质量(LVM)消退的动态变化易于出现差异。本研究的目的是确定经导管主动脉瓣植入术(TAVI)后LVM消退的决定因素。
共纳入134例行TAVI的患者。对基线时以及TAVI术后6至12个月使用经胸超声心动图计算的体表面积指数化LVM(LVMi)进行回顾性分析。
TAVI术后6至12个月,由于左心室壁厚度降低,平均LVMi显著降低(从118.2±26.67g/m²降至103.4±27.07g/m²;p<0.001)。相对壁厚度(RWT)降低(0.54±0.10cm对0.51±0.09cm;p=0.006),而向心性重塑(RWT≥0.42)的患病率保持不变(85.1%对80.6%;p=0.3)。然而,47例患者(35.1%)表现出显著的LVMi消退,但与表现出显著消退的患者相比,其基线LVMi较低(109.8±25.8g/m²对122±26.1g/m²;p=0.008),但其他特征相似。LVMi降低幅度越大与基线LVMi越大相关(r=0.39;p<0.001),LVMi处于最高四分位数的患者LVMi降低最为显著(p<0.001)。多变量分析确定TAVI术前LVMi是TAVI术后6至12个月LVMi消退的唯一独立预测因素(P=0.45;95%置信区间0.255 - 0.534;p<0.001)。
TAVI术后6至12个月LVM消退存在差异,约三分之一的患者未表现出显著消退。只有基线LVM可预测LVM消退;基线LVM较高的患者消退更为显著。