基线左心室射血分数对有或无低梯度主动脉瓣狭窄患者经股动脉经导管主动脉瓣植入术后结局的影响。

Impact of baseline left ventricular ejection fraction on outcome after transfemoral transcatheter aortic valve implantation in patients with and without low-gradient aortic stenosis.

作者信息

El-Chilali Karim, Patsalis Polykarpos Christos, Al-Rashid Fadi, Kahlert Heike Annelie, Riebisch Matthias, Mincu Raluca-Ileana, Totzeck Matthias, Lind Alexander, Jánosi Rolf Alexander, Kehren Clemens, Dirkmann Daniel, Peters Jürgen, Wendt Daniel, Jakob Heinz, Rassaf Tienush, Kahlert Philipp

机构信息

Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, Essen University Hospital, Duisburg-Essen University, Essen, Germany.

Clinic for Anesthesiology and Intensive Care, Essen University Hospital, Duisburg-Essen University, Essen, Germany.

出版信息

Echocardiography. 2019 Jan;36(1):28-37. doi: 10.1111/echo.14203. Epub 2018 Nov 28.

DOI:10.1111/echo.14203

PMID:30484901

Abstract

OBJECTIVES

To evaluate the impact of baseline left ventricular ejection fraction (LVEF) and its interaction with low-gradient aortic stenosis (LGAS) on all-cause mortality after transfemoral aortic valve implantation (TF-TAVI).

METHODS

We reviewed mortality data of 624 consecutive single center TF-TAVI patients and categorized LVEF according to current ASE/EACVI recommendations (normal, mildly-, moderately-, and severely abnormal).

RESULTS

Baseline LVEF was normal in 336 (53.8%), mildly abnormal in 160 (25.6%), moderately abnormal in 91 (14.6%), and severely abnormal in 37 (5.9%) patients, and 1-year mortality was 19%, 17%, 23%, and 43% (P = 0.002), respectively. Patients with LGAS had a similar 1-year mortality compared to those without LGAS in groups with normal (19% vs 19%, P = 0.899) and mildly abnormal LVEF (16% vs 17%, P = 0.898). One-year mortality of patients with LGAS was significantly greater than in those without LGAS in presence of moderately abnormal LVEF (31% vs 11%, P = 0.022), and it was numerically greater than in those without LGAS in presence of severely abnormal LVEF (48% vs 25%, P = 0.219). In multivariate analysis, only the combination of moderately/severely abnormal LVEF and LGAS predicted increased 1-year mortality (HR: 2.12, 95% CI: 1.4-3.2, P < 0.001). Other variables, including EuroSCORE I did not affect this result.

CONCLUSIONS

Moderately/severely abnormal LVEF (≤40%) at baseline is associated with increased mortality after TF-TAVI, especially when the mean transvalvular aortic gradient is <40 mm Hg (LGAS), while outcomes in patients with normal and mildly abnormal LVEF are comparable regardless of the pressure gradient across the native aortic valve. (DRKS00013729).

摘要

目的

评估基线左心室射血分数（LVEF）及其与低梯度主动脉瓣狭窄（LGAS）的相互作用对经股动脉主动脉瓣植入术（TF-TAVI）后全因死亡率的影响。

方法

我们回顾了624例连续的单中心TF-TAVI患者的死亡率数据，并根据当前ASE/EACVI的建议对LVEF进行分类（正常、轻度、中度和重度异常）。

结果

336例（53.8%）患者的基线LVEF正常，160例（25.6%）轻度异常，91例（14.6%）中度异常，37例（5.9%）重度异常，1年死亡率分别为19%、17%、23%和43%（P = 0.002）。在LVEF正常（19%对19%，P = 0.899）和轻度异常的组中，LGAS患者与无LGAS患者的1年死亡率相似（16%对17%，P = 0.898）。在LVEF中度异常时，LGAS患者的1年死亡率显著高于无LGAS患者（31%对11%，P = 0.022），在LVEF重度异常时，其数值上高于无LGAS患者（48%对25%，P = 0.219）。在多变量分析中，只有LVEF中度/重度异常与LGAS的组合预测1年死亡率增加（HR：2.12，95%CI：1.4 - 3.2，P < 0.001）。其他变量，包括欧洲心脏手术风险评估系统I，均不影响这一结果。