Cardiovascular Research Foundation, New York, New York; Structural Heart and Valve Center, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, New York.
Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.
J Am Coll Cardiol. 2020 May 19;75(19):2446-2458. doi: 10.1016/j.jacc.2020.03.042.
Greater early left ventricular mass index (LVMi) regression is associated with fewer hospitalizations 1 year after transcatheter aortic valve replacement (TAVR). The association between LVMi regression and longer-term post-TAVR outcomes is unclear.
The purpose of this study was to determine the association between LVMi regression at 1-year post-TAVR and clinical outcomes between 1 and 5 years.
Among intermediate- and high-risk patients who received TAVR in the PARTNER (Placement of Aortic Transcatheter Valves) I, II, and S3 trials or registries and were alive at 1 year, we included patients with baseline moderate or severe left ventricular hypertrophy (LVH) and paired measurements of LVMi at baseline and 1 year. The associations between LVMi regression (percent change between baseline and 1 year) and death or rehospitalization from 1 to 5 years were examined.
Among 1,434 patients, LVMi was 146 g/m (interquartile range [IQR]: 133 to 168 g/m) at baseline and decreased 14.5% (IQR: 4.2% to 26.1%) to 126 g/m (IQR: 106 to 148 g/m) at 1 year. After adjustment, greater LVMi regression at 1 year was associated with lower all-cause death (adjusted hazard ratio [aHR]: 0.95 per 10% decrease in LVMi; 95% confidence interval [CI]: 0.91 to 0.98; p = 0.004; aHR of the quartile with greatest vs. least LVMi regression: 0.61; 95% CI: 0.43 to 0.86; p = 0.005). Severe LVH at 1 year was observed in 39%, which was independently associated with increased all-cause death (aHR of severe LVH vs. no LVH: 1.71; 95% CI: 1.20 to 2.44; p = 0.003). Similar associations were found for rates of cardiovascular mortality and rehospitalization.
Among patients with moderate or severe LVH treated with TAVR who are alive at 1 year, greater LVMi regression at 1 year is associated with lower death and hospitalization rates to 5 years. These findings may have implications for the timing of valve replacement and the role of adjunctive medical therapy after TAVR.
经导管主动脉瓣置换术（TAVR）后，早期左心室质量指数（LVMi）的较大程度降低与 1 年后的住院次数减少相关。LVMi 降低与 TAVR 后更长期的预后之间的关联尚不清楚。
本研究旨在确定 TAVR 后 1 年时 LVMi 降低与 1 至 5 年期间临床结局之间的相关性。
在 PARTNER（经导管主动脉瓣置换术）I、II 和 S3 试验或登记处接受 TAVR 且在 1 年时存活的中危和高危患者中，纳入基线时存在中度或重度左心室肥厚（LVH）且基线和 1 年时存在 LVMi 配对测量值的患者。研究分析了 LVMi 降低（与基线相比 1 年时的百分比变化）与 1 至 5 年期间死亡或再住院之间的相关性。
在 1434 例患者中，基线时 LVMi 为 146 g/m（四分位距 [IQR]：133 至 168 g/m），1 年后降低 14.5%（IQR：4.2%至 26.1%）至 126 g/m（IQR：106 至 148 g/m）。经调整后，1 年时 LVMi 降低幅度较大与全因死亡降低相关（调整后的危险比 [aHR]：LVMi 每降低 10%，aHR：0.95；95%置信区间 [CI]：0.91 至 0.98；p=0.004；四分位间距中 LVMi 降低幅度最大与最小的四分位间距的 aHR：0.61；95%CI：0.43 至 0.86；p=0.005）。1 年后出现严重 LVH 的比例为 39%，严重 LVH 与全因死亡增加独立相关（严重 LVH 与无 LVH 的 aHR：1.71；95%CI：1.20 至 2.44；p=0.003）。心血管死亡率和再住院率也存在类似的相关性。
在 1 年时存活且接受 TAVR 治疗的中度或重度 LVH 患者中，1 年时 LVMi 降低程度与 5 年时的死亡率和再住院率降低相关。这些发现可能对瓣膜置换的时机以及 TAVR 后的辅助药物治疗的作用具有重要意义。
