经导管主动脉瓣植入术患者的右心室收缩功能：系统评价和荟萃分析。
Right ventricular systolic function in patients undergoing transcatheter aortic valve implantation: A systematic review and meta-analysis.
机构信息
Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands.
Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands.
出版信息
Int J Cardiol. 2018 Apr 15;257:40-45. doi: 10.1016/j.ijcard.2018.01.117. Epub 2018 Jan 31.
BACKGROUND
Right ventricular (RV) systolic dysfunction is associated with worse survival in patients undergoing surgical aortic valve replacement (SAVR), yet it is not included in traditional risk scores of transcatheter aortic valve implantation (TAVI) candidates. We aimed to evaluate the prognostic value of RV systolic function on clinical outcomes in patients undergoing TAVI at one year follow-up; and, echocardiographic changes of RV systolic function up to 12 months after TAVI and compared with SAVR when possible.
METHODS AND RESULTS
This systematic review and meta-analysis is registered in PROSPERO (CRD42017065761). Studies investigating RV systolic function with echocardiography in TAVI cohorts were identified from Medline, Embase and Cochrane databases. We used random-effects models to assess differences in primary outcomes. Twenty-one studies were identified, where RV systolic function and clinical outcomes were assessed in eight (4016 patients) and RV systolic function changes were evaluated in 14 (1709 patients). For the primary outcome of all-cause death at one year, RV systolic dysfunction was associated with a significant 78% relative risk increase (risk ratio[95% confidence interval (CI)]) = 1.78[1.37, 2.31], P < 0.01), albeit significant heterogeneity (I = 64%, P < 0.01). RV systolic function was unchanged after TAVI throughout follow-up as shown with tricuspid annular plane systolic excursion (TAPSE)(mean difference[95% CI]pre-discharge = 0.03 [-0.92,0.99]mm,1-3 months = -0.09[-0.89,0.71]mm,6-12 months = 0.52 [-0.29,1.32] mm, all P = NS), while TAPSE was significantly reduced after SAVR (pre-discharge = -10.17[-13.11,-7.24]mm, P < 0.01;1-3 months = -7.3[-8.17,-6.44]mm, P < 0.01;6-12 months = -5.99[-7.95,-4.03]mm, P < 0.01).
CONCLUSIONS
RV systolic dysfunction was associated with a significant increase in all-cause mortality at one year after TAVI. RV systolic function was unchanged after TAVI up to 12 months, whereas deteriorated significantly after SAVR.
背景
右心室（RV）收缩功能障碍与接受主动脉瓣置换术（SAVR）的患者的生存预后较差相关，但它并未包含在经导管主动脉瓣植入术（TAVI）患者的传统风险评分中。我们旨在评估 RV 收缩功能在接受 TAVI 治疗的患者中 1 年随访时的临床结局的预后价值；并评估 RV 收缩功能的超声心动图变化，直到 TAVI 后 12 个月，并尽可能与 SAVR 进行比较。
方法和结果
这项系统评价和荟萃分析已在 PROSPERO（CRD42017065761）中注册。从 Medline、Embase 和 Cochrane 数据库中确定了使用超声心动图研究 TAVI 队列中 RV 收缩功能的研究。我们使用随机效应模型来评估主要结局的差异。确定了 21 项研究，其中 8 项（4016 例患者）评估了 RV 收缩功能和临床结局，14 项（1709 例患者）评估了 RV 收缩功能变化。对于 1 年时全因死亡的主要结局，RV 收缩功能障碍与显著的 78%相对风险增加相关（风险比[95%置信区间（CI）] = 1.78[1.37, 2.31]，P < 0.01），尽管存在显著的异质性（I = 64%，P < 0.01）。TAVI 后，RV 收缩功能在整个随访过程中保持不变，三尖瓣环平面收缩期位移（TAPSE）（出院时的平均差异[95%CI]预放电= 0.03[-0.92,0.99]mm，1-3 个月=-0.09[-0.89,0.71]mm，6-12 个月= 0.52[-0.29,1.32]mm，所有 P = NS），而 SAVR 后 TAPSE 显著降低（出院时=-10.17[-13.11,-7.24]mm，P < 0.01；1-3 个月=-7.3[-8.17,-6.44]mm，P < 0.01；6-12 个月=-5.99[-7.95,-4.03]mm，P < 0.01）。
结论
TAVI 后 1 年时，RV 收缩功能障碍与全因死亡率显著增加相关。TAVI 后 12 个月内 RV 收缩功能保持不变，而 SAVR 后则明显恶化。
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