Possner Mathias, Vontobel Jan, Nguyen-Kim Thi Dan Linh, Zindel Christoph, Holy Erik W, Stämpfli Simon F, Zuber Michel, Kaufmann Philipp A, Nietlispach Fabian, Maisano Francesco, Niemann Markus, Tanner Felix C
Department of Cardiology, University Heart Center, Zurich, Switzerland; Department of Nuclear Medicine, University Hospital, Zurich, Switzerland.
Institute of Diagnostic and Interventional Radiology, University Hospital, Zurich, Switzerland.
Int J Cardiol. 2016 Oct 15;221:180-7. doi: 10.1016/j.ijcard.2016.06.145. Epub 2016 Jun 25.
Aortic regurgitation (AR) after transcatheter aortic valve implantation (TAVI) for severe aortic valve stenosis results in major haemodynamic changes. Influence of post-implant AR and aortic valve calcification on outcome in patients with chronic kidney disease (CKD) is unclear.
Short-term outcome was defined as a combined 30-day endpoint, long-term outcome as survival. Post-implant AR was classified as none/mild or moderate/severe using transthoracic echocardiography. Aortic valve calcification was calculated by computed tomography. Logistic regression analyses were performed in patients with none/mild (estimated glomerular filtration rate [eGFR]≥30ml/min/1.73m(2)) and advanced (eGFR<30ml/min/1.73m(2)) CKD to evaluate predictors of outcome and post-implant AR.
TAVI was performed in 546 consecutive patients. Moderate/severe post-implant AR was the only independent predictor of the 30-day endpoint in patients with advanced (OR 7.091, 95% CI 1.144-43.962, p=0.035), but not in patients with none/mild CKD. Similarly, moderate/severe AR predicted impaired survival only in patients with advanced CKD (p<0.001). NT-proBNP (OR 1.023 per 500ng/l increase, 95% CI 1.003-1.043; p=0.026) before intervention was the only independent predictor of the 30-day endpoint in patients with none/mild CKD. Aortic valve calcification was comparable in patients with none/mild versus advanced CKD and was an independent predictor of moderate/severe post-implant AR in the overall population as well as in the subgroups with none/mild or advanced CKD.
Moderate/severe AR after TAVI predicts outcome in patients with advanced CKD, but not in patients with none/mild CKD. Aortic valve calcification is an important predictor of post-implant AR independent of kidney function.
经导管主动脉瓣植入术（TAVI）治疗严重主动脉瓣狭窄后发生的主动脉瓣反流（AR）会导致主要的血流动力学改变。植入后AR和主动脉瓣钙化对慢性肾脏病（CKD）患者预后的影响尚不清楚。
短期预后定义为30天综合终点，长期预后定义为生存率。使用经胸超声心动图将植入后AR分为无/轻度或中度/重度。通过计算机断层扫描计算主动脉瓣钙化情况。对无/轻度（估计肾小球滤过率[eGFR]≥30ml/min/1.73m²）和晚期（eGFR<30ml/min/1.73m²）CKD患者进行逻辑回归分析，以评估预后和植入后AR的预测因素。
连续对546例患者进行了TAVI。中度/重度植入后AR是晚期CKD患者30天终点的唯一独立预测因素（OR 7.091，95%CI 1.144 - 43.962，p = 0.035），但在无/轻度CKD患者中并非如此。同样，中度/重度AR仅在晚期CKD患者中预测生存率受损（p<0.001）。干预前NT-proBNP（每增加500ng/l，OR 1.023，95%CI 1.003 - 1.043；p = 0.026）是无/轻度CKD患者30天终点的唯一独立预测因素。无/轻度与晚期CKD患者的主动脉瓣钙化情况相当，并且是总体人群以及无/轻度或晚期CKD亚组中中度/重度植入后AR的独立预测因素。
TAVI后中度/重度AR可预测晚期CKD患者的预后，但不能预测无/轻度CKD患者的预后。主动脉瓣钙化是植入后AR的重要预测因素，与肾功能无关。
