Fischer-Rasokat Ulrich, Renker Matthias, Liebetrau Christoph, Weferling Maren, Rieth Andreas, Rolf Andreas, Choi Yeong-Hoon, Hamm Christian W, Kim Won-Keun
Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany.
Cardiac Surgery, Kerckhoff Heart Center, Bad Nauheim, Germany.
Cardiovasc Diagn Ther. 2021 Oct;11(5):1080-1092. doi: 10.21037/cdt-21-286.
The plasma volume status (PVS) is considered a marker of non-overt cardiac congestion and is of prognostic value. Patients with low-flow, low-gradient (LFLG) aortic stenosis (AS) suffer from impaired left ventricular function and show signs of heart failure (HF). We hypothesized that PVS might predict post-interventional rehospitalization and cardiovascular mortality in high-risk patients undergoing transcatheter aortic valve implantation (TAVI).
In this retrospective, observational analysis, PVS before transfemoral TAVI was calculated by a formula taking into account hematocrit and weight. The predictive performance of PVS was compared with that of prior cardiac decompensation (PCD).
In the entire cohort of n=2,458 patients, PVS >-4% (high plasma volume) identified patients (n=1,013) with a higher post-interventional 1-year mortality rate than patients (n=1,445) with a PVS ≤-4% (low plasma volume). However, PVS lost prognostic independence when adjusted for anemia, whereas PCD did not. A high PVS and PCD were not correlated, and both parameters similarly revealed a low sensitivity and specificity but a high negative predictive value (NPV) for future HF events. PVS was not different between control patients (n=1,512) and those with intermediate (paradoxical LFLG-AS, n=327) or high risk scores (LFLG-AS, n=239). The accuracy of high PVS in predicting adverse events in these subpopulations was the same as in the study population overall. Kaplan-Maier analyses demonstrated similar prognostic impacts for PVS and PCD.
PVS and PCD represent two independent parameters of volume overload with unfavorable prognostic significance. Pre-interventional PVS does not appear to be suitable for predicting clinical outcomes in high-risk patients undergoing TAVI.
血浆容量状态（PVS）被认为是非显性心脏充血的标志物且具有预后价值。低流量、低梯度（LFLG）主动脉瓣狭窄（AS）患者存在左心室功能受损并表现出心力衰竭（HF）迹象。我们假设PVS可能预测经导管主动脉瓣植入术（TAVI）的高危患者介入治疗后的再住院率和心血管死亡率。
在这项回顾性观察分析中，经股动脉TAVI术前的PVS通过一个考虑血细胞比容和体重的公式计算得出。将PVS的预测性能与既往心脏失代偿（PCD）的预测性能进行比较。
在n = 2458例患者的整个队列中，PVS > -4%（高血浆容量）的患者（n = 1013）介入治疗后1年死亡率高于PVS ≤ -4%（低血浆容量）的患者（n = 1445）。然而，校正贫血后PVS失去了预后独立性，而PCD没有。高PVS与PCD不相关，且这两个参数对未来HF事件同样显示出低敏感性和特异性但高阴性预测值（NPV）。对照组患者（n = 1512）与中度（矛盾性LFLG - AS，n = 327）或高风险评分（LFLG - AS，n = 239）患者的PVS无差异。高PVS预测这些亚组患者不良事件的准确性与整个研究人群相同。Kaplan - Meier分析表明PVS和PCD具有相似的预后影响。
PVS和PCD代表容量超负荷的两个独立参数，具有不良预后意义。介入治疗前的PVS似乎不适用于预测接受TAVI的高危患者的临床结局。
