Conrotto Federico, D'Ascenzo Fabrizio, D'Amico Maurizio, Moretti Claudio, Pavani Marco, Scacciatella Paolo, Omedè Pierluigi, Montefusco Antonio, Biondi-Zoccai Giuseppe, Gaita Fiorenzo, Maisano Francesco, Nietlispach Fabian
Division of Cardiology, Città della Salute e della Scienza Hospital, Turin, Italy.
Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy.
Catheter Cardiovasc Interv. 2017 May;89(6):1100-1106. doi: 10.1002/ccd.26839. Epub 2016 Nov 10.
The risk/benefit balance of transcatheter aortic valve implantation (TAVI) in patients with low-gradient aortic stenosis (LGAS) remains to be well defined. Aim of the study was to investigate the impact of LGAS in patients undergoing TAVI.
Medline, Cochrane Library, and Scopus were searched for articles reporting outcome of patients with LGAS undergoing TAVI. The primary endpoint was 12-months all-cause mortality and the secondary endpoint was 30-day all-cause mortality. Using event-rates as dependent variable, a meta-regression was performed to test for interaction between baseline clinical features (age, gender, diabetes mellitus, coronary artery disease, left ventricular ejection fraction (LVEF) and type of implanted valve) and transaortic gradient for the primary endpoint.
Eight studies with a total of 12,589 patients were included. Almost one-third of the patients presented with LGAS (27.3%: 24.4-29.2). Median LVEF was 48% in patients with LGAS and 56% in patients with high-gradient AS. Patients with LGAS were more likely to have diabetes mellitus, previous coronary artery disease, higher mean Logistic EuroSCORE, and lower EF. At 12 (12-16.6) months, low transaortic gradient emerged as independently associated with all-cause death, both if evaluated as a dichotomous and continuous value (respectively OR 1.17; 1.11-1.23 and OR 1.02; 1-1.04, all CI 95%). Clinical variables, including EF did not affect this result.
In a population of TAVI patients, LGAS appears to be independently related to dismal prognosis. © 2016 Wiley Periodicals, Inc.
经导管主动脉瓣植入术（TAVI）在低跨瓣压差主动脉瓣狭窄（LGAS）患者中的风险/获益平衡仍有待明确界定。本研究的目的是调查LGAS对接受TAVI患者的影响。
检索Medline、Cochrane图书馆和Scopus，查找报告LGAS患者接受TAVI结果的文章。主要终点是12个月全因死亡率，次要终点是30天全因死亡率。以事件发生率作为因变量，进行meta回归以检验基线临床特征（年龄、性别、糖尿病、冠状动脉疾病、左心室射血分数（LVEF）和植入瓣膜类型）与主要终点的跨主动脉压差之间的相互作用。
纳入8项研究，共12589例患者。近三分之一的患者表现为LGAS（27.3%：24.4 - 29.2）。LGAS患者的中位LVEF为48%，高跨瓣压差主动脉瓣狭窄患者为56%。LGAS患者更可能患有糖尿病、既往有冠状动脉疾病、平均逻辑欧洲心脏手术风险评估系统（Logistic EuroSCORE）较高且EF较低。在12（12 - 16.6）个月时，低跨主动脉压差被发现与全因死亡独立相关，无论将其评估为二分变量还是连续变量（分别为OR 1.17；1.11 - 1.23和OR 1.02；1 - 1.04，所有CI 95%）。包括EF在内的临床变量并未影响这一结果。
在TAVI患者群体中，LGAS似乎与不良预后独立相关。© 2016威利期刊公司。
