Kjønås Didrik, Schirmer Henrik, Aakhus Svend, Eidet Jo, Malm Siri, Aaberge Lars, Busund Rolf, Rösner Assami
Department of Cardiology, University Hospital of North Norway, Tromsø, Norway.
Department of Cardiology, Akershus University Hospital, Lørenskog, Norway.
Front Cardiovasc Med. 2021 Dec 6;8:739710. doi: 10.3389/fcvm.2021.739710. eCollection 2021.
Transcatheter aortic valve implantation (TAVI) has become a standard treatment option for patients with symptomatic aortic stenosis. Elderly high-risk patients treated with TAVI have a high residual mortality due to preexisting comorbidities. Knowledge of factors predicting futility after TAVI is sparse and clinical tools to aid the preoperative evaluation are lacking. The aim of this study was to evaluate if echocardiographic measures, including speckle-tracking analysis, in addition to clinical parameters, could aid in the prediction of mortality beyond 30 days after TAVI. This prospective observational cohort study included 227 patients treated with TAVI at the University Hospital of North Norway, Tromsø and Oslo University Hospital, Rikshospitalet from February 2010 to June 2013. All the patients underwent preoperative echocardiographic evaluation with retrospective speckle-tracking analysis. Primary endpoints were 1- and 2-year mortality beyond 30 days after TAVI. All-cause 1- and 2-year mortality beyond 30 days after TAVI was 12.1 and 19.5%, respectively. Predictors of 1-year mortality beyond 30 days were body mass index [hazard ratio (HR): 0.88, 95% CI: 0.80-0.98, = 0.018], previous myocardial infarction (HR: 2.69, 95% CI: 1.14-6.32, = 0.023), and systolic pulmonary artery pressure ≥ 60 mm Hg (HR: 5.93, 95% CI: 1.67-21.1, = 0.006). Moderate-to-severe mitral regurgitation (HR: 2.93, 95% CI: 1.53-5.63, = 0.001), estimated glomerular filtration rate (HR: 0.98, 95% CI: 0.96-0.99, = 0.002), and chronic obstructive pulmonary disease (HR: 1.9, 95% CI: 1.01-3.58, = 0.046) were predictors of 2-year mortality. Both the clinical and echocardiographic parameters should be considered when evaluating high-risk patients for TAVI, as both are predictive of 1-and 2-year mortality. Our results support the importance of individual risk assessment using a multidisciplinary, multimodal, and individual approach.
经导管主动脉瓣植入术（TAVI）已成为有症状主动脉瓣狭窄患者的标准治疗选择。接受TAVI治疗的老年高危患者由于存在合并症，残余死亡率较高。关于TAVI后预测治疗无效因素的知识匮乏，且缺乏有助于术前评估的临床工具。本研究的目的是评估除临床参数外，包括斑点追踪分析在内的超声心动图测量是否有助于预测TAVI后30天以上的死亡率。这项前瞻性观察队列研究纳入了2010年2月至2013年6月在挪威北部大学医院特罗姆瑟和奥斯陆大学医院里克斯医院接受TAVI治疗的227例患者。所有患者均接受了术前超声心动图评估及回顾性斑点追踪分析。主要终点为TAVI后30天以上的1年和2年死亡率。TAVI后30天以上的全因1年和2年死亡率分别为12.1%和19.5%。TAVI后30天以上1年死亡率的预测因素为体重指数[风险比（HR）：0.88，95%置信区间（CI）：0.80 - 0.98，P = 0.018]、既往心肌梗死（HR：2.69，95% CI：1.14 - 6.32，P = 0.023）以及收缩期肺动脉压≥60 mmHg（HR：5.93，95% CI：1.67 - 21.1，P = 0.006）。中重度二尖瓣反流（HR：2.93，95% CI：1.53 - 5.63，P = 0.001）、估计肾小球滤过率（HR：0.98，95% CI：0.96 - 0.99，P = 0.002）以及慢性阻塞性肺疾病（HR：1.9，95% CI：1.01 - 3.58，P = 0.046）是2年死亡率的预测因素。在评估TAVI高危患者时，应同时考虑临床和超声心动图参数，因为二者均能预测1年和2年死亡率。我们的结果支持采用多学科、多模式和个体化方法进行个体风险评估的重要性。
