在主动脉瓣狭窄中，“低流量”低到什么程度？接受 TAVI 的真正低流量/低梯度主动脉瓣狭窄患者的回顾性分析。
How low is "low-flow" in aortic stenosis? A retrospective analysis of patients with true low-flow/low-gradient aortic stenosis undergoing TAVI.
机构信息
Department of Cardiology, Heart Center Brandenburg, Bernau bei Berlin, Germany -
Brandenburg Medical School (MHB) Theodor Fontane, Neuruppin, Germany -
出版信息
Minerva Med. 2021 Jun;112(3):322-328. doi: 10.23736/S0026-4806.20.06817-2. Epub 2020 Jul 22.
BACKGROUND
Transcatheter aortic valve implantation (TAVI) is a valuable treatment option for patients with reduced left ventricular ejection fraction (LVEF) and low-flow/low-gradient (LF/LG) aortic stenosis (AS). According to current literature, the presence of severe AS is unlikely in case of severely reduced LVEF and mean pressure gradient (meanPG) below 30 mmHg. However, a considerable number of patients presenting with typical clinical symptoms of severe AS, show gradients below 30 mmHg. We hypothesized, that these patients undergoing TAVI do have a measurable clinical benefit and an improved LVEF.
METHODS
In this single center retrospective cohort study, data from 1199 patients undergoing TAVI between 2013 and 2017 was analyzed. A 6-month follow-up was performed to assess changes in NT-proBNP, NYHA-class, and LVEF.
RESULTS
Thirty patients presented with LVEF<35%, an aortic valve area (AVA<1 cm), and a meanPG below 30 mmHg. Mean logistic EuroSCORE II was 24.05±10.9. Most patients (56%) showed improved NYHA-class upon follow-up. NT-proBNP-levels decreased from 3.901 pg/mL IQR 10.880 to 1.491 pg/mL IQR 2.245 (P<0.001). LVEF increased from 30% IQR 6.25 to 40% IQR 15 (P<0.001).
CONCLUSIONS
Based on our findings TAVI represents a valuable treatment option even in patients with LF/LG AS and PGmean below 30mmHg.
背景
经导管主动脉瓣植入术（TAVI）是射血分数降低（LVEF）和低流量/低梯度（LF/LG）主动脉瓣狭窄（AS）患者的一种有价值的治疗选择。根据目前的文献，严重降低的 LVEF 和低于 30mmHg 的平均压力梯度（meanPG）不太可能存在严重的 AS。然而，相当数量的患者出现严重 AS 的典型临床症状，但梯度低于 30mmHg。我们假设，这些接受 TAVI 的患者确实有可衡量的临床获益和改善的 LVEF。
方法
在这项单中心回顾性队列研究中，分析了 2013 年至 2017 年间接受 TAVI 的 1199 名患者的数据。进行了 6 个月的随访，以评估 NT-proBNP、NYHA 分级和 LVEF 的变化。
结果
30 名患者的 LVEF<35%，主动脉瓣面积（AVA<1cm）和平均 PG<30mmHg。平均 logistic EuroSCORE II 为 24.05±10.9。大多数患者（56%）在随访时 NYHA 分级得到改善。NT-proBNP 水平从 3.901pg/ml IQR 10.880 下降至 1.491pg/ml IQR 2.245（P<0.001）。LVEF 从 30% IQR 6.25 增加到 40% IQR 15（P<0.001）。
结论
根据我们的发现，即使在 LF/LG AS 和 PGmean 低于 30mmHg 的患者中，TAVI 也是一种有价值的治疗选择。
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