经导管主动脉瓣置换术后常规炎症参数对预后的影响及发生率。
Incidence and Impact of Routine Inflammatory Parameters on Outcome after Transcatheter Aortic Valve Replacement.
机构信息
Department of Cardiology and Angiology, University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany.
Department of Medicine, Devision of Cardiology and Emergency Medicine, Knappschaft University Hospital, Ruhr University Bochum, Bochum, Germany.
出版信息
J Interv Cardiol. 2021 Apr 15;2021:6628405. doi: 10.1155/2021/6628405. eCollection 2021.
BACKGROUND
Previous research reported adverse clinical outcomes in association with systemic inflammation (SI) after transcatheter aortic valve replacement (TAVR). However, data characterizing the impact of SI, as reflected by postprocedural routine inflammatory parameters (pRIP), on clinical outcome of patients undergoing TAVR are sparse.
OBJECTIVES
In light of this, the present work aimed to analyze incidence and clinical significance of pRIP after transapical (TA) and transfemoral (TF)-TAVR.
METHODS AND RESULTS
Data of 81 high-risk consecutive patients undergoing TAVR in our center from 2017 to 2018 were analyzed in a retrospective manner. 40 out of 81 patients (49, 4%) were treated via TF access (group A) and 41 patients via TA access (group B). Incidence, cause, and amplitude of pRIP were analyzed in relation to pre- and peri-interventional data. Assessment of outcomes was conducted according to the valve academic research consortium (VARC-2). Postprocedural C-reactive protein (pCRP) and leucocytes (pL) were significantly increased in patients undergoing TA-TAVR (group B) vs. TF-TAVR (group A; 12.1 ± 9.7 vs. 22.1 ± 7.9 mg/dl, < 0.001 and 12.8 ± 4.0 vs. 14.2 ± 3.8/nl, = 0.002); however, there was no significant difference regarding incidence of postprocedural fever (pF) ≥38.0°C (12.5% vs. 22%, = 0.37). Furthermore, we observed a vast (though insignificant) trend towards a longer fever duration in group B vs. group A (9.9 ± 14.9 vs. 3.2 ± 5.9 hours, = 0.06). Further analysis identified pCRP >30 mg/dl (hazard ratio (HR) 3.15, confidence interval (CI) 1.22-8.14, = 0.018) and European System for Cardiac Operative Risk Evaluation (logistic EuroSCORE I (ES)) >20% (HR 2.95, CI 1.17-7.47, = 0.02) as predictors of mortality; in this context, we also discovered a marginally significant trend for pL > 14/nl (HR 2.44, CI 0.97-6.14, = 0.05). Multivariate analysis by use of the fisher`s exact test revealed a significant association between pCRP >30 mg/dl and ES >20% ( < 0.001).
CONCLUSION
pRIP are significantly increased in patients undergoing TA-TAVR. pCRP >30 mg/dl, ES>20%, and pL > 14/nl are hallmark of adverse prognosis and require further investigation.
背景
先前的研究报告称，经导管主动脉瓣置换术（TAVR）后全身炎症（SI）与不良临床结局相关。然而，描述反映术后常规炎症参数（pRIP）的 SI 对 TAVR 患者临床结局影响的数据却很少。
目的
鉴于此，本研究旨在分析经心尖（TA）和经股（TF）-TAVR 术后 pRIP 的发生率和临床意义。
方法和结果
本回顾性研究分析了 2017 年至 2018 年在我院接受 TAVR 的 81 例高危连续患者的数据。81 例患者中，40 例（49.4%）经 TF 入路（A 组），41 例经 TA 入路（B 组）。分析了 pRIP 的发生率、原因和幅度与术前和围手术期数据的关系。根据瓣膜学术研究联盟（VARC-2）评估结果。与 TF-TAVR （A 组）相比，TA-TAVR （B 组）患者术后 C 反应蛋白（pCRP）和白细胞（pL）显著升高（12.1±9.7 与 22.1±7.9mg/dl， <0.001 和 12.8±4.0 与 14.2±3.8/nl， =0.002）；然而，术后发热（pF）≥38.0°C 的发生率无显著差异（12.5%与 22%， =0.37）。此外，我们观察到 B 组的发热持续时间明显较长（9.9±14.9 与 3.2±5.9 小时， =0.06）。进一步分析发现，pCRP>30mg/dl（风险比（HR）3.15，95%置信区间（CI）1.22-8.14， =0.018）和欧洲心脏手术风险评估系统（logistic EuroSCORE I（ES））>20%（HR 2.95，95%CI 1.17-7.47， =0.02）是死亡率的预测因素；在这方面，我们还发现 pL>14/nl（HR 2.44，95%CI 0.97-6.14， =0.05）存在边缘显著趋势。Fisher 精确检验的多变量分析显示，pCRP>30mg/dl 与 ES>20%之间存在显著关联（ <0.001）。
结论
TA-TAVR 患者的 pRIP 显著增加。pCRP>30mg/dl、ES>20%和 pL>14/nl 是不良预后的标志，需要进一步研究。
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