Kiramijyan Sarkis, Koifman Edward, Magalhaes Marco A, Ben-Dor Itsik, Didier Romain, Jerusalem Zachary D, Kumar Sandeep, Tavil-Shatelyan Arpi, Rogers Toby, Steinvil Arie, Gai Jiaxiang, Torguson Rebecca, Satler Lowell F, Pichard Augusto D, Waksman Ron
Section of Interventional Cardiology, MedStar Washington Hospital Center, Georgetown University Hospital, Washington, D.C., USA.
Section of Interventional Cardiology, MedStar Washington Hospital Center, Georgetown University Hospital, Washington, D.C., USA.
Cardiovasc Revasc Med. 2018 Apr;19(3 Pt A):257-262. doi: 10.1016/j.carrev.2017.09.011. Epub 2017 Sep 22.
Evaluation of invasive hemodynamic parameters as prognostic markers of mortality in patients undergoing TAVR.
The value of invasive intraprocedural hemodynamic evaluation of patients undergoing transcatheter aortic valve replacement is unclear.
Consecutive patients who underwent transfemoral TAVR and had complete prospectively collected intraprocedural invasive hemodynamic parameters were retrospectively analyzed. Patients with alternative access, planned general anesthesia, or baseline ≥moderate Tricuspid Regurgitation were excluded. Pre- and post-valve implant parameters included heart rate, systolic and diastolic blood pressures, cardiac output and index, pulmonary arterial systolic and diastolic pressures, transaortic pressure gradient and right atrial pressure. The primary end points were the association of the intraprocedural hemodynamic changes with all-cause mortality at 30days and 1year. Extensive Receiver Operating Characteristic analyses yielded dichotomized threshold of hemodynamic values in association with the binary outcome of mortality.
A total of 312 patients (52% male, mean age 83years) were evaluated. A significant association with 30-day and 1-year mortality was found between intraprocedural post-valve implant cardiac index <1.9 vs. ≥1.9L/min/m (Log-ranked p=0.0286 and p=0.0432, respectively). Four subgroups with pre- and post-valve implant CI changes (L/min/m) were compared: [1] pre<1.9, stable_post<1.9; [2] pre<1.9, improved_post≥1.9; [3] pre≥1.9, stable_post≥1.9; and [4] pre≥1.9, worsened_post<1.9. Group 1 (lower CI with no post-valve improvement) had the worst survival, and Group 3 (higher CI and stable post-valve) had the best survival at 1-year follow-up (Log-ranked p=0.0089).
In patients with severe aortic stenosis undergoing TAVR, invasive monitoring can assess for hemodynamic prognostic markers of survival.
评估有创血流动力学参数作为经导管主动脉瓣置换术（TAVR）患者死亡率的预后标志物。
经导管主动脉瓣置换术患者术中有创血流动力学评估的价值尚不清楚。
对连续接受经股动脉TAVR且前瞻性完整收集术中侵入性血流动力学参数的患者进行回顾性分析。排除采用其他入路、计划全身麻醉或基线存在≥中度三尖瓣反流的患者。瓣膜植入前后的参数包括心率、收缩压和舒张压、心输出量和心指数、肺动脉收缩压和舒张压、跨主动脉压力梯度和右心房压力。主要终点是术中血流动力学变化与30天和1年全因死亡率的相关性。广泛的受试者工作特征分析得出与死亡率二元结果相关的血流动力学值二分阈值。
共评估了312例患者（52%为男性，平均年龄83岁）。术中瓣膜植入后心指数<1.9与≥1.9L/min/m²相比，与30天和1年死亡率存在显著相关性（对数秩检验p分别为0.0286和0.0432）。比较了瓣膜植入前后心指数变化（L/min/m²）的四个亚组：[1]术前<1.9，术后稳定<1.9；[2]术前<1.9，术后改善≥1.9；[3]术前≥1.9，术后稳定≥1.9；[4]术前≥1.9，术后恶化<1.9。第1组（心指数较低且瓣膜植入后无改善）生存率最差，第3组（心指数较高且瓣膜植入后稳定）在1年随访时生存率最佳（对数秩检验p=0.0089）。
在接受TAVR的重度主动脉瓣狭窄患者中，有创监测可评估生存的血流动力学预后标志物。
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