经胸超声心动图衍生参数与经导管瓣膜置换术后长期结局的关系。
Echocardiographic Derived Parameters Association With Long-Term Outcomes After Transcatheter Valve Replacement.
机构信息
Division of Cardiology, Department of Internal Medicine, SIU School of Medicine, United States of America.
Department of Internal Medicine, University of Massachusetts Medical School (UMMS-Baystate), United States of America.
出版信息
Cardiovasc Revasc Med. 2020 Aug;21(8):982-985. doi: 10.1016/j.carrev.2019.12.035. Epub 2020 Jan 7.
BACKGROUND
Transaortic flow, maximum velocity (V max), mean gradient (MG), left ventricular ejection fraction (LVEF), Aortic valve area (AVA) and dimensional index (DI) are important determinants of prognosis in patients with severe aortic stenosis. The specific role of these echocardiography-derived values in predicting prognosis of severe aortic stenosis patients undergoing Transcatheter aortic valve replacement (TAVR) is less defined.
METHODS
We identified all severe AS patients who underwent TAVR between 01/2012 and 6/2016. Baseline characteristics, clinical, procedural and one year follow-up data were obtained. Hierarchical logistic regression was used to assess predictors of 1-year mortality after TAVR. Normal flow (NF) was defined as having stroke volume index (SVI) of ≥35 ml/m2; while low Flow (LF) was defined as SVI < 35 ml/m2. High gradient (HG) was defined as mean gradient of ≥40 mmHg; while low gradient (LG) was defined as <40 mmHg.
RESULTS
A total of 399 patients were analyzed. There were no significant differences in baseline characteristics. LVEF less than 35% was associated with higher rate of 1-year mortality (17.6% LVEF <35% vs. 8.9% LVEF≥35%; RR = 2.19; CI 1.05 to 4.54; P = 0.03). There was no difference in 1-year mortality outcomes after TAVR in relation to: Mean Gradient MG, transaortic flow/Stroke Volume Index SVI, DI, V max or AVA.
CONCLUSION
Low LVEF <35% remains the strongest parameter associated with 1 year mortality after TAVR.
背景
经主动脉血流、最大速度（V max）、平均梯度（MG）、左心室射血分数（LVEF）、主动脉瓣口面积（AVA）和二维指数（DI）是严重主动脉瓣狭窄患者预后的重要决定因素。经胸超声心动图衍生值在预测行经导管主动脉瓣置换术（TAVR）的严重主动脉瓣狭窄患者预后方面的具体作用尚未明确。
方法
我们确定了所有在 2012 年 1 月至 2016 年 6 月期间接受 TAVR 的严重 AS 患者。获取了基线特征、临床、手术和一年随访数据。分层逻辑回归用于评估 TAVR 后 1 年死亡率的预测因素。正常血流（NF）定义为每搏输出量指数（SVI）≥35ml/m2；低血流（LF）定义为 SVI<35ml/m2。高梯度（HG）定义为平均梯度≥40mmHg；低梯度（LG）定义为<40mmHg。
结果
共分析了 399 例患者。两组间基线特征无显著差异。LVEF<35%与 1 年死亡率较高相关（17.6% LVEF<35% vs. 8.9% LVEF≥35%；RR=2.19；95%CI 1.05 至 4.54；P=0.03）。TAVR 后 1 年死亡率的结果与平均梯度 MG、经主动脉血流/每搏输出量指数 SVI、二维指数 DI、V max 或 AVA 无关。
结论
LVEF<35%仍然是与 TAVR 后 1 年死亡率相关的最强参数。
Zotero 插件