经导管主动脉瓣植入术患者的计算血浆容量状态与不良预后相关。
Calculated Plasma Volume Status Is Associated with Adverse Outcomes in Patients Undergoing Transcatheter Aortic Valve Implantation.
作者信息
Seoudy Hatim, Saad Mohammed, Salem Mostafa, Allouch Kassem, Frank Johanne, Puehler Thomas, Salem Mohamed, Lutter Georg, Kuhn Christian, Frank Derk
机构信息
Department of Internal Medicine III, Cardiology and Angiology, Campus Kiel, University Hospital Schleswig-Holstein, D-24105 Kiel, Germany.
DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, D-24105 Kiel, Germany.
出版信息
J Clin Med. 2021 Jul 28;10(15):3333. doi: 10.3390/jcm10153333.
BACKGROUND
Calculated plasma volume status (PVS) reflects volume overload based on the deviation of the estimated plasma volume (ePV) from the ideal plasma volume (iPV). Calculated PVS is associated with prognosis in the context of heart failure. This single-center study investigated the prognostic impact of PVS in patients undergoing transcatheter aortic valve implantation (TAVI).
METHODS
A total of 859 TAVI patients had been prospectively enrolled in an observational study and were included in the analysis. An optimal cutoff for PVS of -5.4% was determined by receiver operating characteristic curve analysis. The primary endpoint was a composite of all-cause mortality or heart failure hospitalization within 1 year after TAVI.
RESULTS
A total of 324 patients had a PVS < -5.4% (no congestion), while 535 patients showed a PVS ≥ -5.4% (congestion). The primary endpoint occurred more frequently in patients with a PVS ≥ -5.4% compared to patients with PVS < -5.4% (22.6% vs. 13.0%, < 0.001). After multivariable adjustment, PVS was confirmed as a significant predictor of the primary endpoint (HR 1.53, 95% CI 1.05-2.22, = 0.026).
CONCLUSIONS
Elevated PVS, as a marker of subclinical congestion, is significantly associated with all-cause mortality and heart failure hospitalization within 1 year after TAVI.
背景
计算得出的血浆容量状态（PVS）基于估计血浆容量（ePV）与理想血浆容量（iPV）的偏差反映容量超负荷情况。在心力衰竭背景下，计算得出的PVS与预后相关。这项单中心研究调查了PVS对接受经导管主动脉瓣植入术（TAVI）患者的预后影响。
方法
共有859例TAVI患者前瞻性纳入一项观察性研究并纳入分析。通过受试者工作特征曲线分析确定PVS的最佳截断值为-5.4%。主要终点是TAVI术后1年内全因死亡或心力衰竭住院的复合终点。
结果
共有324例患者的PVS < -5.4%（无充血），而535例患者的PVS≥-5.4%（充血）。与PVS < -5.4%的患者相比，PVS≥-5.4%的患者中主要终点更频繁出现（22.6%对13.0%，<0.001）。多变量调整后，PVS被确认为主要终点的显著预测因素（HR 1.53，95%CI 1.05 - 2.22，=0.026）。
结论
升高的PVS作为亚临床充血的标志物，与TAVI术后1年内全因死亡和心力衰竭住院显著相关。
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