Truong Vien T, Mazur Wojciech, Broderick John, Egnaczyk Gregory F, Kereiakes Dean J, Sarembock Ian J, Choo Joseph K, Shreenivas Satya, Nagueh Sherif F, Bartone Cheryl, Chung Eugene S
The Heart and Vascular Center and The Lindner Research Center, The Christ Hospital Health Network, Cincinnati, Ohio; The Sue and Bill Butler Research Fellow, The Lindner Research Center, Cincinnati, Ohio.
The Heart and Vascular Center and The Lindner Research Center, The Christ Hospital Health Network, Cincinnati, Ohio.
J Am Soc Echocardiogr. 2020 Nov;33(11):1357-1362.e2. doi: 10.1016/j.echo.2020.06.015. Epub 2020 Aug 20.
The aim of this study was to examine the relationship between baseline left ventricular (LV) geometry and outcomes after transcatheter aortic valve replacement (TAVR).
Patients undergoing TAVR (n = 206) had baseline LV geometry classified as (1) concentric hypertrophy, (2) eccentric hypertrophy, (3) concentric remodeling, or (4) normal. Descriptive statistics, Kaplan-Meier time-to-event analysis, and Cox regression were performed.
Distribution of baseline LV geometry differed between male and female patients (χ = 16.83, P = .001) but not at 1 month (χ = 2.56, P = .47) or 1 year (χ = 5.68, P = .13). After TAVR, a majority of patients with concentric hypertrophy evolved to concentric remodeling. Survival differed across LV geometry groups at 1 year (χ[3] = 8.108, P = .044, log-rank test) and at 6.5 years (χ[3] = 9.023, P = .029, log-rank test). Compared with patients with concentric hypertrophy, patients with normal geometry (hazard ratio, 2.25; 95% CI, 1.12-4.54; P = .023) and concentric remodeling (hazard ratio, 1.89; 95% CI, 1.12-3.17; P = .016) had higher rates of all-cause mortality.
Baseline concentric hypertrophy confers a survival advantage after TAVR. Although baseline patterns of LV geometry appear gender specific (with women demonstrating more concentric hypertrophy), this difference resolves after TAVR.
本研究旨在探讨经导管主动脉瓣置换术（TAVR）后基线左心室（LV）几何形态与预后之间的关系。
接受TAVR的患者（n = 206），其基线LV几何形态分为（1）向心性肥厚，（2）离心性肥厚，（3）向心性重构，或（4）正常。进行描述性统计、Kaplan-Meier事件发生时间分析和Cox回归分析。
男性和女性患者的基线LV几何形态分布存在差异（χ = 16.83，P = .001），但在1个月时（χ = 2.56，P = .47）或1年时（χ = 5.68，P = .13）无差异。TAVR后，大多数向心性肥厚患者演变为向心性重构。LV几何形态组在1年时（χ[3] = 8.108，P = .044，对数秩检验）和6.5年时（χ[3] = 9.023，P = .029，对数秩检验）的生存率存在差异。与向心性肥厚患者相比，几何形态正常（风险比，2.25；95% CI，1.12 - 4.54；P = .023）和向心性重构（风险比，1.89；95% CI，1.12 - 3.17；P = .016）的患者全因死亡率更高。
基线向心性肥厚在TAVR后具有生存优势。尽管LV几何形态的基线模式似乎存在性别特异性（女性表现出更多的向心性肥厚），但这种差异在TAVR后消失。
