Department of Medical Sciences, Cardiology, Uppsala University, Akademiska sjukhuset, 751 85, Uppsala, Sweden.
Uppsala Clinical Research Center, Uppsala University, Dag Hammarskjölds Väg 38, 751 85, Uppsala, Sweden.
Eur Heart J Qual Care Clin Outcomes. 2022 Mar 2;8(2):127-134. doi: 10.1093/ehjqcco/qcab008.
Left ventricular ejection fraction (LVEF) affects the outcome of aortic valve replacement (AVR) in aortic stenosis (AS). The study aim was to investigate the prognostic importance of concomitant cardiovascular disease in relation to pre-operative LVEF.
All adult patients undergoing AVR due to AS 2008-14 in a national register for heart diseases were included. All-cause mortality and hospitalization for heart failure during follow-up after AVR, stratified by preserved or reduced LVEF (≤50%), were derived from national patient registers and analysed by Cox regression. During the study period, 10 406 patients, median age 73 years, a median follow-up of 35 months were identified. Preserved LVEF was present in 7512 (72.2%). Among them, 647 (8.6%) had a history of heart failure (HF) and 1099 (14.6%) atrial fibrillation (AF) before the intervention. Pre-operative HF was associated with higher mortality irrespective of preserved or reduced LVEF: hazard ratio (HR) 1.64 [95% confidence interval (CI) 1.35-1.99] and 1.58 (95% CI 1.30-1.92). Prior AF was associated with a higher risk of mortality in patients with preserved but not in those with reduced LVEF: HR 1.62 (95% CI 1.36-1.92) and 1.05 (95% CI 0.86-1.28). Irrespective of LVEF, pre-operative HF and AF were associated with an increased risk of post-operative heart failure hospitalization.
In patients planned for AVR, a history of HF or AF, irrespective of LVEF, worsens the post-operative prognosis. Heart failure and AF can be seen as markers of myocardial fibrosis not necessarily discovered by LVEF and the merely use of it, besides symptoms, for the timing of AVR seems suboptimal.
左心室射血分数（LVEF）影响主动脉瓣置换术（AVR）治疗主动脉瓣狭窄（AS）的结果。本研究旨在探讨术前 LVEF 相关的同时存在的心血管疾病的预后重要性。
所有 2008 年至 2014 年期间在全国心脏病注册中心因 AS 接受 AVR 的成年患者均纳入本研究。通过 Cox 回归分析，从全国患者登记处获得 AVR 后随访期间的全因死亡率和心力衰竭住院率，并根据保留或降低的 LVEF（≤50%）进行分层。在研究期间，共确定了 10406 例患者，中位年龄为 73 岁，中位随访时间为 35 个月。7512 例患者（72.2%）存在 LVEF 保留。其中，647 例（8.6%）在干预前有心衰（HF）病史，1099 例（14.6%）有房颤（AF）病史。术前 HF 与无论保留或降低 LVEF 均与死亡率升高相关：风险比（HR）为 1.64[95%置信区间（CI）1.35-1.99]和 1.58（95% CI 1.30-1.92）。术前 AF 与保留 LVEF 患者的死亡率升高相关，但与降低 LVEF 患者的死亡率升高不相关：HR 为 1.62（95% CI 1.36-1.92）和 1.05（95% CI 0.86-1.28）。无论 LVEF 如何，术前 HF 和 AF 与术后心力衰竭住院风险增加相关。
在计划接受 AVR 的患者中，HF 或 AF 的病史，无论 LVEF 如何，都会使术后预后恶化。HF 和 AF 可以被视为心肌纤维化的标志物，不一定被 LVEF 发现，仅使用 LVEF 加上症状来确定 AVR 的时机似乎并不理想。
