Angelillis Marco, Giannini Cristina, De Carlo Marco, Adamo Marianna, Nardi Matilde, Colombo Antonio, Chieffo Alaide, Bedogni Francesco, Brambilla Nedy, Tamburino Corrado, Barbanti Marco, Bruschi Giuseppe, Colombo Paola, Poli Arnaldo, Martina Paola, Violini Roberto, Presbitero Patrizia, Petronio Anna Sonia
Cardio-Thoracic Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
Cardio-Thoracic Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
Am J Cardiol. 2017 Nov 1;120(9):1639-1647. doi: 10.1016/j.amjcard.2017.07.064. Epub 2017 Aug 1.
Patients with severe aortic stenosis and reduced left ventricular ejection fraction (LVEF) have a poor prognosis compared with patients with preserved LVEF. To evaluate the impact of early LVEF recovery in patients with baseline dysfunction on clinical outcomes after transcatheter aortic valve implantation (TAVI), we included all consecutive patients who underwent TAVI from the Italian ClinicalService registry with an LVEF of ≤45% at baseline who had 1-month LVEF data. Patients who experienced a previous coronary artery bypass graft, a previous valve replacement, or a previous myocardial infarction were excluded from the analysis. Therefore, 131 patients with an improvement in LVEF of <10% (no-R group) were compared with 121 patients with an improvement in LVEF of ≥10% (R group). The primary end point was the rate of death of any cause. Multivariable analysis was performed to determine independent predictors of lack in LVEF recovery. Early LVEF recovery occurred in 48% of the patients, generally before discharge. One-year all-cause mortality and major adverse cardiac and cerebrovascular events were significantly higher in the no-early recovery group (log rank test p = 0.005 and p = 0.003, respectively). Baseline severe left ventricular dysfunction and previous percutaneous coronary intervention were identified as independent predictors to warn the lack of improvement in LVEF. In conclusion, nearly 50% of patients with preoperative left ventricular dysfunction demonstrated a significant early improvement in LVEF after TAVI. Lack of early LVEF recovery is associated with a worse clinical outcome and is most likely among patients with a severely abnormal baseline LVEF and a previous percutaneous coronary intervention.
与左心室射血分数（LVEF）保留的患者相比，重度主动脉瓣狭窄且LVEF降低的患者预后较差。为了评估基线功能障碍患者早期LVEF恢复对经导管主动脉瓣植入术（TAVI）后临床结局的影响，我们纳入了意大利临床服务登记处所有连续接受TAVI且基线LVEF≤45%且有1个月LVEF数据的患者。曾经历过冠状动脉搭桥术、瓣膜置换术或心肌梗死的患者被排除在分析之外。因此，将131例LVEF改善<10%的患者（无恢复组）与121例LVEF改善≥10%的患者（恢复组）进行比较。主要终点是任何原因导致的死亡率。进行多变量分析以确定LVEF恢复不足的独立预测因素。48%的患者出现早期LVEF恢复，通常在出院前。无早期恢复组的1年全因死亡率和主要不良心脑血管事件显著更高（对数秩检验p分别为0.005和0.003）。基线严重左心室功能障碍和既往经皮冠状动脉介入治疗被确定为LVEF缺乏改善的独立预测因素。总之，近50%术前左心室功能障碍的患者在TAVI后LVEF早期有显著改善。早期LVEF恢复不足与更差的临床结局相关，最可能出现在基线LVEF严重异常且既往有经皮冠状动脉介入治疗的患者中。
