Shimura Tetsuro, Yamamoto Masanori, Yamaguchi Ryo, Adachi Yuya, Sago Mitsuru, Tsunaki Tatsuya, Kagase Ai, Koyama Yutaka, Otsuka Toshiaki, Yashima Fumiaki, Tada Norio, Naganuma Toru, Yamawaki Masahiro, Yamanaka Futoshi, Shirai Shinichi, Mizutani Kazuki, Tabata Minoru, Ueno Hiroshi, Takagi Kensuke, Watanabe Yusuke, Hayashida Kentaro
Department of Cardiology, Toyohashi Heart Center, 21-1 Gobudori, Oyamachyo, Toyohashi, Aichi, 441-8530, Japan.
Department of Cardiology, Nagoya Heart Center, Nagoya, Japan.
ESC Heart Fail. 2021 Jun;8(3):1990-2001. doi: 10.1002/ehf2.13270. Epub 2021 Mar 5.
This study investigated the prognostic value of plasma volume status (PVS) in patients who underwent transcatheter aortic valve replacement (TAVR).
Plasma volume status was calculated in 2588 patients who underwent TAVR using data from the Japanese multicentre registry. All-cause mortality and heart failure hospitalization (HFH) within 2 years of TAVR were compared among the PVS quartiles (Q1, PVS < 5.5%; Q2, PVS 5.5-13.5%; Q3, PVS 13.5-21.0%; and Q4, PVS ≥ 21.0%). Subgroups were stratified by the PVS cut-off value combined with the New York Heart Association (NYHA) class as follows: low PVS with NYHA I/II (n = 959), low PVS with NYHA III/IV (n = 845), high PVS with NYHA I/II (n = 308), and high PVS with NYHA III/IV (n = 476). The cumulative all-cause mortality and HFH within 2 years of TAVR significantly increased with increasing PVS quartiles [8.5%, 16.8%, 19.2%, and 27.0% (P < 0.001) and 5.8%, 8.7%, 10.3%, and 12.9% (P < 0.001), respectively]. The high-PVS group regardless of the NYHA class had a higher all-cause mortality and HFH [9.6%, 18.2%, 24.5%, and 30.4% (P < 0.001) and 6.1%, 10.4%, 14.1%, and 11.3% (P < 0.001)]. In a Cox regression multivariate analysis, the PVS values of Q3 and Q4 had independently increased all-cause mortality [hazard ratio (HR), 1.50 and 1.64 (P = 0.017 and P = 0.008), respectively], and Q4 had independently increased HFH (HR, 1.98, P = 0.005). The low PVS with NYHA III/IV, high PVS with NYHA I/II, and high PVS with NYHA III/IV also had significantly increased all-cause mortality [HR, 1.45, 1.73, and 1.86 (P = 0.006, P = 0.002, and P < 0.001), respectively] and HFH [HR, 1.52, 2.21, and 1.70 (P = 0.049, P = 0.002, and P = 0.031), respectively].
Plasma volume status is useful for predicting all-cause mortality and HFH after TAVR.
本研究调查了经导管主动脉瓣置换术（TAVR）患者血浆容量状态（PVS）的预后价值。
利用日本多中心注册研究的数据，计算了2588例行TAVR患者的血浆容量状态。比较了PVS四分位数（Q1，PVS<5.5%；Q2，PVS 5.5 - 13.5%；Q3，PVS 13.5 - 21.0%；Q4，PVS≥21.0%）组间TAVR术后2年内的全因死亡率和心力衰竭住院率（HFH）。根据PVS临界值结合纽约心脏协会（NYHA）分级将亚组分层如下：NYHA I/II级低PVS组（n = 959）、NYHA III/IV级低PVS组（n = 845）、NYHA I/II级高PVS组（n = 308）和NYHA III/IV级高PVS组（n = 476）。TAVR术后2年内累积全因死亡率和HFH随PVS四分位数增加而显著升高[分别为8.5%、16.8%、19.2%和27.0%（P<0.001）以及5.8%、8.7%、10.3%和12.9%（P<0.001）]。无论NYHA分级如何，高PVS组的全因死亡率和HFH均较高[分别为9.6%、18.2%、24.5%和30.4%（P<0.001）以及6.1%、10.4%、14.1%和11.3%（P<0.001）]。在Cox回归多因素分析中，Q3和Q4的PVS值独立增加了全因死亡率[风险比（HR）分别为1.50和1.64（P = 0.017和P = 0.008）]，Q4独立增加了HFH（HR，1.98，P = 0.005）。NYHA III/IV级低PVS组、NYHA I/II级高PVS组和NYHA III/IV级高PVS组的全因死亡率[HR分别为1.45、1.73和1.86（P = 0.006、P = 0.002和P<0.001）]和HFH[HR分别为1.52、2.21和1.70（P = 0.049、P = 0.002和P = 0.031）]也显著增加。
血浆容量状态有助于预测TAVR术后的全因死亡率和HFH。
