Division of Cardiovascular Surgery Severance Cardiovascular HospitalYonsei University College of Medicine Seoul Korea.
J Am Heart Assoc. 2020 Dec 15;9(24):e018292. doi: 10.1161/JAHA.120.018292. Epub 2020 Dec 8.
Background The objectives of the present study were (1) to evaluate the echocardiographic prognostic factors associated with improved left ventricular (LV) systolic function after aortic valve replacement, and (2) to compare the long-term outcomes after aortic valve replacement in chronic aortic regurgitation (AR) patients with or without LV dysfunction. Methods and Results A total of 280 patients who underwent aortic valve replacement because of chronic aortic regurgitation were studied. Patients with reduced LV systolic function (LV ejection fraction [LVEF] <50%; group reduced LVEF [rEF]; N=80) were compared with those with preserved LV systolic function (LVEF ≥50%; group preserved LVEF; N=200). Postoperative clinical outcomes, overall survival, and freedom from cardiac death were compared. Postoperative echocardiographic examinations were reviewed, and changes in echocardiographic parameters were analyzed. The parameters related to LVEF improvement or normalization were evaluated, and risk factors affecting long-term survival were identified. Follow-up was complete in 100% of patients, with a median follow-up of 104.8 months. Overall and cardiac mortality-free survival rates at postoperative 10 years were 80.1% and 92.9% and 87.3% and 97.2% in groups rEF and preserved LVEF, respectively (=0.036 and =0.058, respectively). LVEF tended to decrease in the early postoperative period but improved thereafter in both groups. Preoperative early diastolic transmitral flow velocity/mitral annular tissue velocity ratio was a parameter of postoperative improvement or normalization of LVEF in all patients (area under the curve, 0.719; =0.003) and in group rEF patients (area under the curve, 0.726; =0.011) with a cutoff value of 12.73. Preoperative early diastolic transmitral flow velocity/mitral annular tissue velocity ratio also was the parameter of overall survival in all patients (hazard ratio [HR], 1.08; =0.001) and in group rEF patients (HR, 1.08; =0.005). Conclusions Long-term outcomes and survival after aortic valve replacement were related to preoperative LV function in patients with chronic aortic regurgitation. Preoperative early diastolic transmitral flow velocity/mitral annular tissue velocity ratio was correlated with the postoperative improvement or normalization of LVEF and long-term survival, especially in group rEF patients.
背景 本研究的目的是：（1）评估与主动脉瓣置换术后左心室（LV）收缩功能改善相关的超声心动图预后因素，以及（2）比较慢性主动脉瓣反流（AR）患者伴或不伴 LV 功能障碍行主动脉瓣置换术后的长期结果。 方法和结果 共纳入 280 例因慢性主动脉瓣反流而行主动脉瓣置换术的患者。LV 收缩功能降低（LV 射血分数[LVEF]＜50%；组 1，即射血分数降低组[rEF]；n=80）的患者与 LV 收缩功能保留（LVEF≥50%；组 2，即射血分数保留组；n=200）的患者进行比较。比较术后临床结局、总生存率和免于心脏死亡。回顾术后超声心动图检查，并分析超声心动图参数变化。评估与 LVEF 改善或正常化相关的参数，并确定影响长期生存的危险因素。所有患者均完成了 100%的随访，中位随访时间为 104.8 个月。rEF 组和射血分数保留组术后 10 年总生存率和无心脏死亡率分别为 80.1%和 92.9%、87.3%和 97.2%（=0.036 和=0.058）。两组患者的 LVEF 在术后早期均有下降趋势，但此后均有所改善。所有患者（曲线下面积 0.719；=0.003）和 rEF 组患者（曲线下面积 0.726；=0.011）中，术前早期舒张期二尖瓣血流速度/二尖瓣环组织速度比值均为术后 LVEF 改善或正常化的参数，且截值为 12.73。该比值也是所有患者（危险比[HR]，1.08；=0.001）和 rEF 组患者（HR，1.08；=0.005）的总生存参数。 结论 慢性主动脉瓣反流患者主动脉瓣置换术后的长期结局和生存与术前 LV 功能有关。术前早期舒张期二尖瓣血流速度/二尖瓣环组织速度比值与术后 LVEF 的改善或正常化及长期生存相关，尤其是 rEF 组患者。
