Department of Cardiology, University Medical Center Goettingen, Goettingen, Germany.
EuroIntervention. 2017 Jun 20;13(3):286-293. doi: 10.4244/EIJ-D-16-00801.
The objective of this study was to examine the impact of guideline-defined subtypes of severe aortic stenosis (AS) on long-term outcomes after TAVI.
Four hundred (400) consecutive patients who underwent TAVI (203 transapical, 197 transfemoral) at our institution 8/2008-3/2013 were followed systematically (for up to seven years). One hundred and forty-seven (147) individuals suffered from NEF-HG AS (LV-EF ≥50%, high Pmean ≥40 mmHg), 63 from LEF-HG AS (LV-EF <50%, high gradient), 77 from PLF-LG AS (LV-EF ≥50%, low gradient, stroke volume index [SVI] <35 ml/m²), and 81 from LEF-LG AS (LV-EF <50%, low gradient). LEF-LG status was associated with the highest all-cause and cardiovascular mortality and MACCE rate, whereas NEF-HG patients exhibited the best outcome (i.e., median survival 5.1 years in NEF-HG vs. 1.3 years in LEF-LG, p=0.0006; or vs. 3.3 years in PLF-LG, p=0.02). In multivariate analysis, LEF-LG status emerged as the outcome predictor with the highest hazard ratio for all-cause mortality (HR 2.86, p=0.003), cardiovascular mortality (HR 6.53, p<0.0001), and MACCE (HR 2.44, p=0.007), whereas neither baseline EF nor SVI <35 ml/m² independently predicted these endpoints.
These findings suggest that an assessment of LV-EF alone for outcome prediction after TAVI is inadequate; it is the guideline-defined subtype of AS that determines outcome.
本研究旨在探讨指南定义的重度主动脉瓣狭窄（AS）亚组对经导管主动脉瓣置换术（TAVI）后长期预后的影响。
本研究连续纳入了 2008 年 8 月至 2013 年 3 月在我院接受 TAVI（经心尖 203 例，经股动脉 197 例）的 400 例患者，并对其进行了系统随访（最长达 7 年）。147 例患者为射血分数保留的重度主动脉瓣狭窄（左心室射血分数[EF]≥50%，平均压力阶差[Pmean]≥40mmHg），63 例为射血分数降低的重度主动脉瓣狭窄（左心室 EF<50%，存在高梯度），77 例为射血分数保留的轻度主动脉瓣狭窄伴低梯度（左心室 EF≥50%，低梯度，每搏输出量指数[SVI]<35ml/m²），81 例为射血分数降低的轻度主动脉瓣狭窄伴低梯度（左心室 EF<50%，低梯度）。LEF-LG 状态与全因和心血管死亡率及 MACCE 发生率最高相关，而 NEF-HG 患者的预后最佳（即，NEF-HG 组的中位生存时间为 5.1 年，LEF-LG 组为 1.3 年，p=0.0006；或与 PLF-LG 组的 3.3 年相比，p=0.02）。多变量分析显示，LEF-LG 状态是全因死亡率（HR 2.86，p=0.003）、心血管死亡率（HR 6.53，p<0.0001）和 MACCE（HR 2.44，p=0.007）的最强预后预测因素，而基线 EF 或 SVI<35ml/m² 均不能独立预测这些终点。
这些发现表明，TAVI 后仅评估左心室 EF 用于预后预测是不够的；指南定义的 AS 亚组决定了预后。
