Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota.
Catheter Cardiovasc Interv. 2020 Oct 1;96(4):972-978. doi: 10.1002/ccd.28805. Epub 2020 Feb 20.
We sought to quantify and compare changes in quality of life measures after transcatheter aortic valve replacement (TAVR) in patients with low-flow (LF) and normal-flow (NF) aortic stenosis (AS).
We included 297 patients treated with TAVR at Abbott Northwestern Hospital from January 2015 to October 2017. Health status was assessed at baseline and 30 days post-procedure using the Kansas City Cardiomyopathy Questionnaire 12 (KCCQ-12). Overall (KCCQ-OS) and domain-specific (physical limitation, symptom frequency, quality of life, and social limitation) scores were compared in three subsets of patients as defined by stroke volume index (≤ or >35 ml/m ), ejection fraction (EF) (≤ or >40%), and mean gradient (≤ or >40 mmHg).
Of the 297 patients included, 129 (43%) had NF high-gradient (NF AS group) and 168 (56%) had LF severe AS, including 25 (8%) with low EF (8%) ("Classical" low-flow low-gradient LEF [LF-LG-LEF] group) and 143 (48%) with preserved EF ("Paradoxical" LF-LG group). At baseline, patients with LF-LG-LEF AS had more severe impairment in symptoms frequency (p = .06) but similar KCCQ-OS. At 1-month after TAVR, all groups had moderate improvements in quality of life (Delta KCCQ-OS: "Classical" LF-LG-LEF 18 ± 21, paradoxical AS 14 ± 18, and NF AS 15 ± 16, p = .57). During a median follow-up time of 2.4 years, there was no difference in mortality (p = .34) but patients with paradoxical LF-LG AS had a higher risk of rehospitalization for heart failure (p = .01).
Patients with LF severe AS derive significant improvements in quality of life measures after TAVR, indistinguishable from patients with NF AS.
我们旨在量化并比较经导管主动脉瓣置换术（TAVR）治疗低流量（LF）和正常流量（NF）主动脉瓣狭窄（AS）患者后的生活质量变化。
我们纳入了 2015 年 1 月至 2017 年 10 月在雅培西北医院接受 TAVR 治疗的 297 例患者。在基线和术后 30 天使用堪萨斯城心肌病问卷 12 （KCCQ-12）评估健康状况。根据每搏输出量指数（≤或>35ml/m ）、射血分数（EF）（≤或>40%）和平均梯度（≤或>40mmHg），将患者分为三组，比较三组患者的总体（KCCQ-OS）和特定领域（身体受限、症状频率、生活质量和社会限制）评分。
在纳入的 297 例患者中，129 例（43%）为 NF 高梯度（NF AS 组），168 例（56%）为 LF 严重 AS，其中 25 例（8%）EF 降低（8%）（“经典”低流量低梯度 LF [LF-LG-LEF]组）和 143 例（48%）EF 正常（“反常”LF-LG 组）。基线时，LF-LG-LEF AS 患者的症状频率更严重（p =.06），但 KCCQ-OS 相似。TAVR 后 1 个月，所有组的生活质量均有中度改善（KCCQ-OS 变化：“经典”LF-LG-LEF 18 ± 21，反常 AS 14 ± 18，NF AS 15 ± 16，p =.57）。在中位随访时间 2.4 年期间，死亡率无差异（p =.34），但反常 LF-LG AS 患者因心力衰竭再住院的风险更高（p =.01）。
LF 严重 AS 患者 TAVR 后生活质量指标显著改善，与 NF AS 患者无差异。
