Ueno Yohei, Imamura Teruhiko, Oshima Akira, Onoda Hiroshi, Ushijima Ryuichi, Sobajima Mitsuo, Fukuda Nobuyuki, Ueno Hiroshi, Kinugawa Koichiro
Second Department of Internal Medicine, University of Toyama, Toyama 9300194, Japan.
J Clin Med. 2022 Jan 5;11(1):280. doi: 10.3390/jcm11010280.
Respiratory instability, which can be quantified using respiratory stability time (RST), is associated with the severity and prognostic impact of the disease in patients with chronic heart failure. However, its clinical implications in patients with severe aortic stenosis receiving transcatheter aortic valve replacement (TAVR) remain unknown.
Patients who received TAVR and had paired measurements of RST at a baseline and one week following TAVR were prospectively included. Changes in RST following TAVR and its impact on post-TAVR heart failure readmissions were investigated.
Seventy-one patients (median age, 86 years old; 35% men) were included. The baseline RST was correlated with the severity of heart failure including elevated levels of plasma B-type natriuretic peptide ( < 0.05 for all). RST improved significantly following TAVR from 34 (26, 37) s to 36 (33, 38) s ( < 0.001). Post-TAVR lower RST (<33 s, = 18) was associated with a higher 2-year cumulative incidence of heart failure readmission (21% vs. 8%, = 0.039) with a hazard ratio of 5.47 (95% confidence interval 0.90-33.2).
Overall, respiratory instability improved following TAVR. Persistent respiratory instability following TAVR was associated with heart failure recurrence.
呼吸不稳定可通过呼吸稳定时间（RST）进行量化，与慢性心力衰竭患者疾病的严重程度及预后影响相关。然而，其在接受经导管主动脉瓣置换术（TAVR）的严重主动脉瓣狭窄患者中的临床意义仍不清楚。
前瞻性纳入接受TAVR且在基线及TAVR后1周进行RST配对测量的患者。研究TAVR后RST的变化及其对TAVR后心力衰竭再入院的影响。
纳入71例患者（中位年龄86岁；35%为男性）。基线RST与心力衰竭严重程度相关，包括血浆B型利钠肽水平升高（所有P<0.05）。TAVR后RST显著改善，从34（26，37）秒增至36（33，38）秒（P<0.001）。TAVR后较低的RST（<33秒，n=18）与较高的2年心力衰竭再入院累积发生率相关（21%对8%，P=0.039），风险比为5.47（95%置信区间0.90-33.2）。
总体而言，TAVR后呼吸不稳定情况有所改善。TAVR后持续的呼吸不稳定与心力衰竭复发相关。
