Department of Medicine, Division of Cardiology, University of Minnesota Medical School, Minneapolis, Minnesota.
Department of Interventional Cardiology, Valve Science Center, Minneapolis Heart Institute, Minneapolis, Minnesota.
Catheter Cardiovasc Interv. 2020 Apr 1;95(5):1034-1041. doi: 10.1002/ccd.28444. Epub 2019 Aug 16.
There is conflicting data as to whether diastolic dysfunction (DD) affects the prognosis of patients with aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR).
Consecutive patients undergoing TAVR underwent assessment of DD with preoperative echocardiography and NT-pro BNP. Long-term survival was ascertained every 6 months by clinic visits or phone. DD was graded according to the new American Society of Echocardiography recommendations. Health status was assessed at baseline and 30 days post-procedure using the KCCQ-12 questionnaire. Long-term survival was displayed using Kaplan-Meier curves according to NT-pro BNP levels and DD grades.
We included 222 patients, mean age 78 (±8) years, median STS score 4 (interquartile range = 3-7), median follow-up time 385 days (IQR = 180-640). DD was absent in 25, Grade I in 13, Grade II in 74, Grade III in 24, and indeterminate in 86 patients. Advanced (Grades II-III) DD was associated with higher pre-procedural NT-pro BNP levels (p < .001), worse quality of life (p < .001) but similar surgical risk (p = .43). Advanced and indeterminate DD were associated with increased long-term mortality (25-28% vs. 5%, p = .02) and elevated NT-pro BNP levels (26.4% vs. 9.8%, p = .05). Improvements in quality of life measures were seen in all DD groups (median change in KCCQ score no or Grade I DD:14 [3-21] vs. Grades II-III DD: 15 [16-26; p = .37]).
Preoperative NT-pro BNP levels and echocardiographic indices of indeterminate or advanced DD are associated with increased long-term mortality after TAVR but similar improvements in quality of life.
关于舒张功能障碍（DD）是否会影响行经导管主动脉瓣置换术（TAVR）的主动脉瓣狭窄（AS）患者的预后，目前存在相互矛盾的数据。
连续接受 TAVR 的患者在术前接受超声心动图和 NT-pro BNP 评估 DD。通过门诊或电话每 6 个月确定长期生存情况。根据新的美国超声心动图学会建议对 DD 进行分级。使用 KCCQ-12 问卷在基线和术后 30 天评估健康状况。根据 NT-pro BNP 水平和 DD 分级，使用 Kaplan-Meier 曲线显示长期生存情况。
我们纳入了 222 例患者，平均年龄 78（±8）岁，中位 STS 评分 4（四分位距=3-7），中位随访时间 385 天（IQR=180-640）。25 例患者无 DD，13 例患者为 I 级，74 例患者为 II 级，24 例患者为 III 级，86 例患者为不确定级。高级（II-III 级）DD 与较高的术前 NT-pro BNP 水平相关（p<0.001），生活质量更差（p<0.001），但手术风险相似（p=0.43）。高级和不确定级 DD 与长期死亡率增加相关（25-28%比 5%，p=0.02）和 NT-pro BNP 水平升高（26.4%比 9.8%，p=0.05）。所有 DD 组的生活质量指标均有改善（无或 I 级 DD 的 KCCQ 评分中位数变化：14[3-21]比 II-III 级 DD：15[16-26]；p=0.37）。
术前 NT-pro BNP 水平和不确定或高级 DD 的超声心动图指标与 TAVR 后长期死亡率增加相关，但生活质量的改善相似。
