经导管主动脉瓣置换术后动脉僵硬度的预后影响。
Prognostic impact of arterial stiffness following transcatheter aortic valve replacement.
机构信息
Division of Cardiology, Mitsui Memorial Hospital, Kanda-Izumicho 1, Chiyoda-ku, Tokyo 101-8643, Japan.
Division of Cardiology, Mitsui Memorial Hospital, Kanda-Izumicho 1, Chiyoda-ku, Tokyo 101-8643, Japan.
出版信息
J Cardiol. 2021 Jul;78(1):37-43. doi: 10.1016/j.jjcc.2021.01.007. Epub 2021 Jan 28.
BACKGROUND
Increased left ventricular (LV) afterload in patients with aortic stenosis consists of valvular and vascular loads; however, the effects of vascular load induced by arterial stiffness on clinical outcomes after transcatheter aortic valve replacement (TAVR) remain unclear. This study evaluated the prognostic value of brachial-ankle pulse wave velocity (baPWV) after TAVR.
METHODS
A retrospective study including 161 consecutive patients who underwent TAVR with a pre-procedural baPWV assessment was conducted. We investigated the association between baPWV and the 1-year composite outcome comprising all-cause death and rehospitalization related to heart failure. Echocardiographic measurements including the LV mass index (LVMi) and LV diastolic function at 1, 6, and 12 months after TAVR were assessed.
RESULTS
Of the 161 patients, 31 patients experienced composite outcome within 1 year after TAVR. The receiver operating characteristic curve analysis revealed that the discriminating baPWV level to discern 1-year composite outcome was 1,639 cm/s, and all subjects were allocated to two groups based on the result. Baseline characteristics were comparable between the high baPWV (n = 72) and low baPWV groups (n = 89). The Kaplan-Meier curve revealed a significantly higher cumulative 1-year composite outcome in the high baPWV group than in the low baPWV group (31% vs. 10%; log-rank test, p<0.001). High baPWV was an independent predictor of the 1-year composite outcome (adjusted hazard ratio, 3.42; 95% confidence interval, 1.62-7.85; p = 0.002). Furthermore, post-procedural echocardiography revealed that the high baPWV group had less LVMi regression and higher E/e' after TAVR compared to the low baPWV group. The delayed reversal in LVMi and diastolic function attributable to arterial stiffness might be linked to impaired clinical outcomes after TAVR.
CONCLUSIONS
Higher baPWV could be associated with adverse clinical outcomes and delayed reverse LV remodeling after TAVR.
背景
主动脉瓣狭窄患者的左心室（LV）后负荷增加包括瓣膜负荷和血管负荷；然而，动脉僵硬度引起的血管负荷对经导管主动脉瓣置换术（TAVR）后的临床结局的影响尚不清楚。本研究评估了 TAVR 后肱踝脉搏波速度（baPWV）的预后价值。
方法
进行了一项回顾性研究，纳入了 161 例接受 TAVR 并进行术前 baPWV 评估的连续患者。我们研究了 baPWV 与 1 年复合终点（包括全因死亡和心力衰竭相关再住院）之间的关系。在 TAVR 后 1、6 和 12 个月评估了超声心动图测量值，包括 LV 质量指数（LVMi）和 LV 舒张功能。
结果
在 161 例患者中，31 例患者在 TAVR 后 1 年内发生复合结局。受试者工作特征曲线分析显示，区分 1 年复合结局的可辨别的 baPWV 水平为 1,639 cm/s，根据结果将所有患者分为两组。高 baPWV 组（n=72）和低 baPWV 组（n=89）的基线特征无差异。Kaplan-Meier 曲线显示，高 baPWV 组的 1 年累积复合结局明显高于低 baPWV 组（31%比 10%；对数秩检验，p<0.001）。高 baPWV 是 1 年复合结局的独立预测因子（调整后的危险比，3.42；95%置信区间，1.62-7.85；p=0.002）。此外，与低 baPWV 组相比，TAVR 后高 baPWV 组的 LVMi 逆转减少，E/e'更高。动脉僵硬导致的 LV 重构延迟逆转可能与 TAVR 后临床结局受损有关。
结论
较高的 baPWV 可能与 TAVR 后的不良临床结局和 LV 重构逆转延迟有关。
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