Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea; Division of Cardiology, Department of Internal Medicine, Chungnam National University Sejong Hospital, Chungnam National University College of Medicine, Daejeon, Republic of Korea.
Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea; Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea.
Int J Cardiol. 2021 Jun 1;332:60-66. doi: 10.1016/j.ijcard.2021.03.053. Epub 2021 Mar 26.
Paravalvular regurgitation (PVR) has been known to be the primary determinant of poor left ventricular (LV) mass regression after transcatheter aortic valve replacement (TAVR). However, the incidence of significant PVR has been reduced considerably as TAVR technology evolved rapidly. This study aimed to investigate the time course and impact of LV mass index (LVMi) regression on long-term clinical outcomes in severe aortic stenosis (AS) patients without significant PVR after TAVR.
Of 412 patients who underwent TAVR, 146 who had LV hypertrophy (LVMi ≥115 g/m for men and ≥ 95 g/m for women) at baseline and were alive at one year after TAVR were enrolled. The primary outcome was cardiovascular deaths and the impact of LVMi regression on clinical outcomes were examined. The patients with significant PVR were excluded.
During a median follow-up of 40 months (interquartile range, 26-58 months), 9 (6.2%) cardiovascular deaths, 21 (14.4%) all-cause deaths, and 9 (6.2%) hospitalizations occurred. In the multivariable analysis, the percentage change of LVMi was an independent predictor of cardiovascular deaths (adjusted hazard ratio [HR], 1.03; 95% confidential interval [CI], 1.01-1.05; P = 0.010), and composite outcome of cardiovascular deaths and rehospitalization for heart failure (adjusted HR, 1.02; 95% CI, 1.00-1.04; P = 0.022). Baseline LVMi, eccentric hypertrophy, and TAVR-induced left bundle branch block were independently associated with LVMi regression.
In patients with severe AS who received successful TAVR without significant PVR, the degree of LVMi regression is an independent predictor of postoperative outcomes after TAVR.
瓣周漏（PVR）一直是经导管主动脉瓣置换（TAVR）后左心室（LV）质量反 弹的主要决定因素。然而，随着 TAVR 技术的快速发展，显著 PVR 的发生率已大大降低。本研究旨在探讨无显著 PVR 的重度主动脉瓣狭窄（AS）患者 TAVR 后 LV 质量指数（LVMi）反 弹的时间过程及其对长期临床结局的影响。
在接受 TAVR 的 412 例患者中，纳入了 146 例基线时存在 LV 肥厚（男性 LVMi≥115g/m，女性 LVMi≥95g/m）且 TAVR 后 1 年存活的患者。主要结局是心血管死亡，检 查了 LVMi 反 弹对临床结局的影响。排除了有显著 PVR 的患者。
在中位随访 40 个月（四分位距，26-58 个月）期间，发生了 9 例（6.2%）心血管死亡、21 例（14.4%）全因死亡和 9 例（6.2%）住院事件。多变量分析中，LVMi 的变化百分比是心血管死亡的独立预测因子（调整后的危险比 [HR]，1.03；95%置信区间 [CI]，1.01-1.05；P=0.010），也是心血管死亡和因心力衰竭再次住院的复合结局的独立预测因子（调整后的 HR，1.02；95%CI，1.00-1.04；P=0.022）。基线 LVMi、偏心肥厚和 TAVR 诱导的左束支传导阻滞与 LVMi 反 弹独立相关。
在接受成功 TAVR 且无显著 PVR 的重度 AS 患者中，LVMi 反 弹程度是 TAVR 后术后结局的独立预测因子。
