Department of Cardiology, Tenri Hospital, Tenri, Japan; Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
Department of Cardiovascular Medicine, Kobe City Medical Center General Hosp, Nishinomiya, Japan.
Am J Cardiol. 2019 Jul 1;124(1):105-112. doi: 10.1016/j.amjcard.2019.04.010. Epub 2019 Apr 9.
There have been few studies with a large number of patients on the effect of left ventricular (LV) reverse remodeling and long-term outcomes after aortic valve replacement (AVR). This study aimed to investigate long-term outcomes and the prognostic impact of follow-up echocardiographic parameters after AVR. We evaluated 456 consecutive patients from a retrospective multicenter registry in Japan (J-PROVE-Retro) who underwent AVR for aortic valve diseases (predominantly aortic stenosis [AS]; 326 patients and aortic regurgitation [AR]; 130 patients). Preoperative and follow-up echocardiography at 1 year after AVR was evaluated. The primary outcome measure was a composite of cardiac death or hospitalization due to heart failure. The median follow-up period was 9.2 years in AS group and 9.7 years in AR group. The freedom rate from the primary outcome was 92% at 5 years and 79% at 10 years in AS, and 97% at 5 years, and 93% at 10 years in AR. LV end-diastolic and end-systolic diameters, and the LV mass index decreased and LV ejection fraction increased after AVR in both AS and AR, and LV mass index was normalized in more than half of the patients. In the Cox proportional hazard model, echocardiographic parameters at 1 year after AVR were more strongly related to long-term outcomes than preoperative echocardiographic parameters. In conclusion, echocardiographic parameters at 1 year after AVR are more important as predictors of long-term outcomes than preoperative parameters in both AS and AR. More attention should be paid on early postoperative remodeling for long-term follow-up of patients after AVR.
关于主动脉瓣置换（AVR）后左心室（LV）逆向重构和长期结局的影响，仅有少数研究纳入了大量患者。本研究旨在探讨 AVR 后长期结局和随访超声心动图参数的预后影响。我们评估了来自日本（J-PROVE-Retro）回顾性多中心注册的 456 例连续患者，这些患者因主动脉瓣疾病（主要为主动脉瓣狭窄[AS]；326 例和主动脉瓣反流[AR]；130 例）接受了 AVR。评估了 AVR 后 1 年的术前和随访超声心动图。主要结局测量指标是心脏性死亡或因心力衰竭住院的复合终点。AS 组的中位随访时间为 9.2 年，AR 组为 9.7 年。AS 组的 5 年和 10 年无主要结局生存率分别为 92%和 79%，AR 组分别为 97%和 93%。AS 和 AR 患者在 AVR 后 LV 舒张末期和收缩末期直径以及 LV 质量指数减小，LV 射血分数增加，LV 质量指数在一半以上的患者中得到正常化。在 Cox 比例风险模型中，AVR 后 1 年的超声心动图参数与长期结局的相关性强于术前超声心动图参数。总之，在 AS 和 AR 中，AVR 后 1 年的超声心动图参数比术前参数更能预测长期结局。对于 AVR 后患者的长期随访，应更加关注术后早期重构。
