Cardiovascular Research Foundation, New York, NY, USA.
Structural Heart and Valve Center, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA.
EuroIntervention. 2022 Jan 28;17(13):1053-1060. doi: 10.4244/EIJ-D-20-01293.
Moderate or worse paravalvular regurgitation (PVR) post transcatheter aortic valve replacement (TAVR) is associated with increased mortality. The mechanisms by which this occurs are not fully understood.
The aim of this study was to determine the mechanism by which PVR leads to worse outcomes.
A total of 1,974 intermediate-risk patients who received TAVR in the PARTNER 2 trial and registries were grouped by PVR severity. Clinical and echocardiographic outcomes were compared.
Overall 1,176 (60%) patients had none/trace, 680 (34%) had mild, and 118 (6%) had ≥moderate PVR. At two years, ≥moderate PVR patients had increased risks of all-cause (HR 2.33 [1.41-3.85], p-value=0.001) and cardiovascular death (HR 3.30 [1.74-6.28], p-value <0.001), rehospitalisation (HR 2.68 [1.57-4.58], p-value <0.001), and reintervention (HR 14.72 [3.13-69.32], p-value <0.001). Moderate or worse PVR was associated with larger increases in left ventricular (LV) end-diastolic and systolic dimensions and volumes, LV mass indices, and reductions in LV ejection fractions (LVEFs) from 30 days to two years. Mild PVR was not associated with worse outcomes. Adjusting for LV dimensions and LVEF from the one-year echocardiogram, patients with ≥moderate PVR still had an increased risk of all-cause death or rehospitalisation at two years (HR 2.84 [1.25-5.78], p-value=0.009).
Moderate or worse PVR, but not mild PVR, is associated with an increased risk of all-cause and cardiovascular death, rehospitalisation, and reintervention at two years. Moderate or worse PVR is also associated with adverse LV remodelling, which partially mediates how ≥moderate PVR leads to worse outcomes. These results provide dual insights on the deleterious impact of ≥moderate PVR and the contributing mechanisms of poor clinical outcomes.
经导管主动脉瓣置换术（TAVR）后中度或重度瓣周漏（PVR）与死亡率增加相关。其发生的机制尚不完全清楚。
本研究旨在确定 PVR 导致不良结局的机制。
共纳入 PARTNER 2 试验和注册研究中 1974 例接受 TAVR 的中危患者，根据 PVR 严重程度分组。比较临床和超声心动图结果。
总体而言，1176 例（60%）患者无/微量，680 例（34%）患者轻度，118 例（6%）患者≥中度 PVR。两年时，≥中度 PVR 患者全因死亡（HR 2.33 [1.41-3.85]，p 值=0.001）和心血管死亡（HR 3.30 [1.74-6.28]，p 值<0.001）、再住院（HR 2.68 [1.57-4.58]，p 值<0.001）和再介入（HR 14.72 [3.13-69.32]，p 值<0.001）风险增加。中度或重度 PVR 与左心室（LV）舒张末期和收缩末期内径及容积、LV 质量指数的更大增加以及从 30 天到两年时 LV 射血分数（LVEF）的降低相关。轻度 PVR 与不良结局无关。调整一年时超声心动图的 LV 直径和 LVEF 后，≥中度 PVR 患者两年时仍有全因死亡或再住院的风险增加（HR 2.84 [1.25-5.78]，p 值=0.009）。
中度或重度 PVR（而非轻度 PVR）与两年时全因死亡和心血管死亡、再住院和再介入的风险增加相关。中度或重度 PVR 还与不良 LV 重构相关，这部分解释了≥中度 PVR 导致不良结局的机制。这些结果为≥中度 PVR 的有害影响和不良临床结局的促成机制提供了双重见解。
