Komatsu Ikki, Hart Chari, Lau Jeffrey, Spies Christian
Cardiovascular Interventional & Surgical Services, The Queen's Medical Center, 550 South Beretania Street, Suite 702, Honolulu, HI, 96813, USA.
Department of Cardiology, Tokyo Medical University, 6-7-1 Nishishinjyuku, Shinjyuku, Tokyo, 1600023, Japan.
Heart Vessels. 2020 Sep;35(9):1209-1217. doi: 10.1007/s00380-020-01591-3. Epub 2020 Apr 6.
Predictors of left ventricular ejection fraction (LVEF) improvement after transcatheter aortic valve replacement (TAVR) in patients with a preoperative reduced LVEF are limited.
This study aimed to investigate the relationship between preprocedural valuvuloarterial impedance (ZVa), which represents the global LV afterload, and LVEF improvement after TAVR.
This was a single-center, retrospective study, which included patients with symptomatic aortic valve stenosis (AS) with a reduced baseline LVEF (< 50%) underwent TAVR. Based on the difference in the LVEF before and 1 month after the procedure, they were divided into two groups: improved group (≥ 10% improvement) and non-improved group (< 10% improvement or worsening). Preprocedural ZVa and clinical outcomes were then compared. ZVa was calculated using preprocedural transthoracic echocardiography data.
Among 473 cases of TAVR performed from May 2012 to July 2017 at Queen's Medical Center (Honolulu, HI, USA), 99 patients (improved group, n = 42; mean age 82.0 ± 8.6 years vs. non-improved group, n = 57, mean age 81.4 ± 9.5 years) were included. The improved group had a higher baseline ZVa {4.83 (4.15-6.89) mmHg/ml/m vs. 4.04 (3.56-4.63) mmHg/ml/m, respectively, p = 0.0009} and prevalence of ZVa > 5 mmHg/ml/m (45.2% vs. 17.5%, respectively, p = 0.0028). Multivariable analysis of predictors of LVEF improvement ≥ 10% at 1 month identified ZVa > 5 mmHg/ml/m [odds ratio (OR): 3.31, 95% confidence interval (CI): 1.05-11.8] as a predictor. The improved group had a lower readmission rate due to heart failure than the non-improved group (log-rank test, p = 0.043).
In conclusion, Zva is a simple, noninvasive marker that shows promise as a predictor of LVEF improvement after TAVR in reduced LVEF patients.
术前左心室射血分数（LVEF）降低的患者经导管主动脉瓣置换术（TAVR）后LVEF改善的预测因素有限。
本研究旨在探讨代表左心室整体后负荷的术前瓣膜动脉阻抗（ZVa）与TAVR后LVEF改善之间的关系。
这是一项单中心回顾性研究，纳入了有症状的主动脉瓣狭窄（AS）且基线LVEF降低（<50%）并接受TAVR的患者。根据术前和术后1个月LVEF的差异将患者分为两组：改善组（改善≥10%）和未改善组（改善<10%或恶化）。然后比较术前ZVa和临床结局。ZVa使用术前经胸超声心动图数据计算。
在2012年5月至2017年7月于美国夏威夷檀香山女王医疗中心进行的473例TAVR病例中，纳入了99例患者（改善组，n = 42；平均年龄82.0±8.6岁，未改善组，n = 57，平均年龄81.4±9.5岁）。改善组的基线ZVa更高{分别为4.83（4.15 - 6.89）mmHg/ml/m对4.04（3.56 - 4.63）mmHg/ml/m，p = 0.0009}，且ZVa>5 mmHg/ml/m的患病率更高（分别为45.2%对17.5%，p = 0.0028）。对术后1个月LVEF改善≥10%的预测因素进行多变量分析，确定ZVa>5 mmHg/ml/m[比值比（OR）：3.31，95%置信区间（CI）：1.05 - 11.8]为预测因素。改善组因心力衰竭的再入院率低于未改善组（对数秩检验，p = 0.043）。
总之，Zva是一个简单的非侵入性标志物，有望作为术前LVEF降低患者TAVR后LVEF改善的预测指标。
