Anand Vidhu, Adigun Rosalyn O, Thaden Jeremy T, Pislaru Sorin V, Pellikka Patricia A, Nkomo Vuyisile T, Greason Kevin L, Pislaru Cristina
Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
Department of Cardiovascular Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
Eur Heart J Cardiovasc Imaging. 2020 Oct 1;21(10):1160-1168. doi: 10.1093/ehjci/jez292.
Despite improvements in cardiac haemodynamics and symptoms, long-term mortality remains increased in some patients after aortic valve replacement (AVR). Limited data exist on the prognostic role of left ventricular (LV) chamber stiffening in these patients.
We performed a retrospective analysis in 1893 patients with severe aortic stenosis (AS) referred for AVR. LV end-diastolic pressure-volume relations (EDPVR, P = αV^β) were reconstructed from echocardiographic measurements of end-diastolic volumes and estimates of end-diastolic pressure (EDP). The impact of EDPVR-derived LV chamber stiffness (CS30, at 30 mmHg EDP) on all-cause mortality after AVR was evaluated. Mean age was 76 ± 10 years, 39% were females, and ejection fraction (EF) was 61 ± 12%. The mean LV chamber stiffness (CS30) was 2.2 ± 1.3 mmHg/mL. A total of 877 (46%) patients had high LV stiffness (CS30 >2 mmHg/mL). In these patients, the EDPVR curves were steeper and shifted leftwards, indicating higher stiffness at all pressure levels. These patients were slightly older, more often female, and had more prevalent comorbidities compared to patients with low stiffness. At follow-up [median 4.2 (interquartile range 2.8-6.3) years; 675 deaths], a higher CS30 was associated with lower survival (hazard ratio: 2.7 for severe vs. mild LV stiffening; P < 0.0001), both in patients with normal or reduced EF. At multivariate analysis, CS30 remained an independent predictor, even after adjusting for age, sex, comorbidities, EF, LV remodelling, and diastolic dysfunction.
Higher preoperative LV chamber stiffening in patients with severe AS is associated with poorer outcome despite successful AVR.
尽管主动脉瓣置换术（AVR）后部分患者的心脏血流动力学和症状有所改善，但其长期死亡率仍有所增加。关于左心室（LV）腔硬化在这些患者中的预后作用的数据有限。
我们对1893例因严重主动脉瓣狭窄（AS）接受AVR的患者进行了回顾性分析。通过超声心动图测量舒张末期容积和舒张末期压力（EDP）的估计值，重建左心室舒张末期压力-容积关系（EDPVR，P =αV^β）。评估了由EDPVR得出的左心室腔硬度（CS30，在30 mmHg EDP时）对AVR后全因死亡率的影响。平均年龄为76±10岁，女性占39%，射血分数（EF）为61±12%。左心室腔平均硬度（CS30）为2.2±1.3 mmHg/mL。共有877例（46%）患者左心室硬度较高（CS30>2 mmHg/mL）。在这些患者中，EDPVR曲线更陡峭且向左移位，表明在所有压力水平下硬度更高。与低硬度患者相比，这些患者年龄稍大，女性更多见，合并症更普遍。在随访期间[中位时间4.2（四分位间距2.8 - 6.3）年；675例死亡]，无论是EF正常还是降低的患者，较高的CS30都与较低的生存率相关（危险比：严重左心室硬化与轻度左心室硬化相比为2.7；P < 0.0001）。在多变量分析中，即使在调整了年龄、性别、合并症、EF、左心室重构和舒张功能障碍后，CS30仍然是一个独立的预测因素。
严重AS患者术前较高的左心室腔硬化与AVR成功后较差的预后相关。
