Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
Heart Center, Bad Segeberg, Germany.
Am J Cardiol. 2019 Jul 1;124(1):78-84. doi: 10.1016/j.amjcard.2019.04.007. Epub 2019 Apr 9.
Cardiovascular magnetic resonance (CMR) has demonstrated a high accuracy for evaluating the severity of aortic regurgitation (AR). However, scarce data exist on the impact of AR as evaluated by CMR on clinical outcomes following transcatheter aortic valve implantation (TAVI). The objective of this study was to evaluate the impact of AR as determined by CMR on clinical outcomes (mortality, heart failure [HF] hospitalization) post-TAVI. A total of 448 TAVI recipients from 2 centers (mean age: 80 ± 7 years, mean STS: 5.8 ± 5.4%) who survived the periprocedural period with no pacemaker implantation were included. A newer generation transcatheter valve system was used in 213 patients (48%). The CMR examination was performed at a median of 12 (IQR: 7 to 21) days post-TAVI. After a mean follow-up of 24 ± 19 months, a total of 94 patients (21%) had died and 72 patients (16%) had at least 1 hospitalization because of decompensated HF. The aortic regurgitation fraction (RF) as determined by CMR was an independent predictor of mortality (hazard ratio[HR]:1.06 for each increase of 10%, 95% confidence interval [CI]: 1.01 to 1.12, p = 0.03) and HF hospitalization (HR:1.15 for each increase of 10%, 95% CI:1.02 to 1.30, p = 0.02). The rate of moderate-severe CMR-AR defined as a RF ≥30% was 3%, and this was associated with an increased risk of mortality (HR: 2.63, 95% CI: 2.30 to 2.99, p <0.001) and HF hospitalization (HR: 2.96, 95% CI: 1.62 to 5.42, p ˂0.001). A stepwise increase in the risk of mortality and HF hospitalization was observed with an increase in AR severity, with a peak increase among patients with RF ≥30%. In conclusion, our results showed the clinical usefulness of evaluating AR severity by CMR post-TAVI. CMR would be particularly helpful in doubtful cases or those with discordances between echocardiography and clinical data.
心血管磁共振（CMR）已证明在评估主动脉瓣反流（AR）严重程度方面具有较高的准确性。然而，关于经导管主动脉瓣植入术（TAVI）后由 CMR 评估的 AR 对临床结局的影响的数据很少。本研究的目的是评估 CMR 确定的 AR 对 TAVI 后临床结局（死亡率、心力衰竭[HF]住院）的影响。共有 2 个中心的 448 名 TAVI 接受者（平均年龄：80 ± 7 岁，平均 STS：5.8 ± 5.4%）在无起搏器植入的围手术期存活下来，并接受了检查。在 213 名患者（48%）中使用了新一代经导管瓣膜系统。CMR 检查在 TAVI 后中位数 12 天（IQR：7 至 21 天）进行。平均随访 24 ± 19 个月后，共有 94 名患者（21%）死亡，72 名患者（16%）因失代偿性 HF 至少住院 1 次。CMR 确定的主动脉瓣反流分数（RF）是死亡率的独立预测因子（危险比[HR]：每增加 10%，95%置信区间[CI]：1.01 至 1.12，p=0.03）和 HF 住院（HR：每增加 10%，95% CI：1.02 至 1.30，p=0.02）。定义为 RF≥30%的中度至重度 CMR-AR 的发生率为 3%，与死亡率增加相关（HR：2.63，95%CI：2.30 至 2.99，p<0.001）和 HF 住院（HR：2.96，95%CI：1.62 至 5.42，p<0.001）。随着 AR 严重程度的逐步增加，观察到死亡率和 HF 住院风险的增加，在 RF≥30%的患者中增加幅度最大。总之，我们的结果表明 TAVI 后通过 CMR 评估 AR 严重程度具有临床实用性。CMR 在超声心动图与临床数据不一致或存在疑问的情况下特别有帮助。
