右心室功能对接受经导管主动脉瓣置换术的严重主动脉瓣狭窄患者预后的影响。
Impact of right ventricular function on outcome of severe aortic stenosis patients undergoing transcatheter aortic valve replacement.
作者信息
Koifman Edward, Didier Romain, Patel Nirav, Jerusalem Zack, Kiramijyan Sarkis, Ben-Dor Itsik, Negi Smita I, Wang Zuyue, Goldstein Steven A, Lipinski Michael J, Torguson Rebecca, Gai Jiaxiang, Pichard Augusto D, Satler Lowell F, Waksman Ron, Asch Federico M
机构信息
Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.
Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.
出版信息
Am Heart J. 2017 Feb;184:141-147. doi: 10.1016/j.ahj.2016.09.018. Epub 2016 Oct 29.
BACKGROUND
Right ventricular (RV) dysfunction was shown to be associated with adverse outcomes in a variety of cardiac patients and is considered a risk factor for adverse outcome according to the updated Valve Academic Research Consortium criteria.
OBJECTIVE
Our goal was to assess the impact of RV function at baseline on 1-year mortality among patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR).
METHODS
All patients with severe AS treated with TAVR from May 2007 to March 2015 at our center were included in the present study, and baseline and procedural characteristics were recorded for each patient. The patients were categorized according to RV function at baseline as assessed by current guidelines, and a comparison of mortality rates up to 1 year was performed.
RESULTS
Among 650 patients, 606 had adequate echocardiogram quality and 146 (24%) had RV dysfunction. There were significant differences between the 2 groups, as patients with RV dysfunction were younger (81±9 vs 84±7 years, P=.01) and were more likely to be male (65% vs 42%, P<.001). In addition, patients with RV dysfunction had higher rates of prior myocardial infarction (26% vs 16%, P=.02) and atrial fibrillation (51% vs 39%, P=.02). Echocardiographic parameters demonstrated higher rates of left ventricular ejection fraction <40% (40% vs 18%, P<.001), tricuspid regurgitation above moderate (16% vs 9%, P=.04), and higher pulmonary artery systolic pressure (50±17 vs 44±16 mm Hg, P<.001) among patients with severe AS and RV dysfunction compared with patients with normal RV function. Despite the unfavorable cardiac function, patients with severe AS undergoing TAVR have similar functional class (P=.22) and mortality rates at 1year (27% vs 23%, log-rank P=.45).
CONCLUSIONS
Patients with severe AS and RV dysfunction have similar 1-year mortality and functional class after TAVR to patients with normal RV function. The presence of RV dysfunction does not correlate with outcome in patients with severe AS.
背景
右心室（RV）功能障碍在各类心脏疾病患者中均与不良预后相关，并且根据最新的瓣膜学术研究联盟标准，被视为不良预后的一个危险因素。
目的
我们的目标是评估基线右心室功能对接受经导管主动脉瓣置换术（TAVR）的严重主动脉瓣狭窄（AS）患者1年死亡率的影响。
方法
本研究纳入了2007年5月至2015年3月在我们中心接受TAVR治疗的所有严重AS患者，并记录每位患者的基线和手术特征。根据现行指南评估的基线右心室功能对患者进行分类，并对1年内的死亡率进行比较。
结果
在650例患者中，606例超声心动图质量良好，146例（24%）存在右心室功能障碍。两组之间存在显著差异，右心室功能障碍患者更年轻（81±9岁 vs 84±7岁，P = 0.01），且男性比例更高（65% vs 42%，P < 0.001）。此外，右心室功能障碍患者既往心肌梗死发生率更高（26% vs 16%，P = 0.02），房颤发生率更高（51% vs 39%，P = 0.02）。超声心动图参数显示，与右心室功能正常的严重AS患者相比，严重AS且右心室功能障碍患者的左心室射血分数<40%的比例更高（40% vs 18%，P < 0.001），三尖瓣反流中度以上的比例更高（16% vs 9%，P = 0.04），肺动脉收缩压更高（50±17 vs 44±16 mmHg，P < 0.001）。尽管心功能不佳，但接受TAVR的严重AS患者的功能分级相似（P = 0.22），1年死亡率也相似（27% vs 23%，对数秩检验P = 0.45）。
结论
严重AS且右心室功能障碍患者TAVR术后1年死亡率和功能分级与右心室功能正常患者相似。严重AS患者中右心室功能障碍的存在与预后无关。
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