Kaneko Hidehiro, Hoelschermann Frank, Schau Thomas, Tambor Grit, Neuss Michael, Butter Christian
Herzzentrum Brandenburg in Bernau/Berlin & Medizinische Hochschule Brandenburg Theodor Fontane, Ladeburger Straße 17, 16321, Bernau, Germany.
Cardiovasc Interv Ther. 2018 Jul;33(3):232-238. doi: 10.1007/s12928-017-0473-x. Epub 2017 May 31.
Transcatheter aortic valve implantation (TAVI) is an alternative therapeutic option for severe aortic stenosis. Aortic regurgitation (AR) is commonly observed after TAVI and increases the mortality rate. We hypothesized that the influence of significant AR, defined as that more severe than mild AR, on survival rate after TAVI might differ according to the baseline left ventricular ejection fraction (LVEF) and N-terminal pro-B-type natriuretic peptide (NT-pro BNP) level. We categorized 856 patients who underwent transfemoral TAVI into 2 groups according to their baseline LVEF (<40 and ≥40%) and NT-pro BNP levels (≤5000 and >5000 pg/mL). Significant AR was observed in 92 patients (11%). Among patients with significant AR, the proportion of patients with CoreValve/EvolutR implantation was higher than that of patients with SAPIEN XT/3 implantation. Kaplan-Meier curves and the log-rank test showed that significant AR was not associated with 1-year mortality in patients with LVEF ≥40% and those with NT-pro BNP level ≤5000 pg/mL. On the other hand, it was significantly associated with a higher 1-year mortality in patients with LVEF <40% (p = 0.003) and those with NT-pro BNP level >5000 pg/mL (p = 0.011). Similarly, multivariate Cox regression analysis showed that the presence of AR was significantly associated with a higher 1-year mortality in patients with LVEF <40% [p = 0.005, hazard ratio (HR) = 3.626] and NT-pro BNP level >5000 pg/mL (p = 0.004, HR = 3.221). However, AR was not significantly associated with a higher 1-year mortality in patients with LVEF ≥40% and NT-pro BNP level ≤5000 pg/mL. Thus, the impact of significant AR on mortality after TAVI seems to be considerable in patients with reduced LVEF or high NT-pro BNP levels, but not those with preserved LVEF or low NT-pro BNP levels, suggesting that the influence of AR differs depending on the baseline LVEF and NT-pro BNP level.
经导管主动脉瓣植入术（TAVI）是重度主动脉瓣狭窄的一种替代治疗选择。TAVI术后常见主动脉瓣反流（AR），且会增加死亡率。我们假设，定义为比轻度AR更严重的显著AR对TAVI术后生存率的影响可能因基线左心室射血分数（LVEF）和N末端B型利钠肽原（NT-pro BNP）水平而异。我们根据基线LVEF（<40%和≥40%）和NT-pro BNP水平（≤5000和>5000 pg/mL）将856例行经股动脉TAVI的患者分为两组。92例患者（11%）观察到显著AR。在有显著AR的患者中，植入CoreValve/EvolutR的患者比例高于植入SAPIEN XT/3的患者。Kaplan-Meier曲线和对数秩检验显示，显著AR与LVEF≥40%且NT-pro BNP水平≤5000 pg/mL的患者1年死亡率无关。另一方面，它与LVEF<40%（p = 0.003）和NT-pro BNP水平>5000 pg/mL（p = 0.011）的患者较高的1年死亡率显著相关。同样，多因素Cox回归分析显示，AR的存在与LVEF<40%[p = 0.005，风险比（HR）= 3.626]和NT-pro BNP水平>5000 pg/mL（p = 0.004，HR = 3.221）的患者较高的1年死亡率显著相关。然而，AR与LVEF≥40%且NT-pro BNP水平≤5000 pg/mL的患者较高的1年死亡率无显著相关。因此，显著AR对TAVI术后死亡率的影响在LVEF降低或NT-pro BNP水平高的患者中似乎相当大，但在LVEF保留或NT-pro BNP水平低的患者中并非如此，这表明AR的影响因基线LVEF和NT-pro BNP水平而异。
