Ito Asahiro, Izumiya Yasuhiro, Iwata Shinichi, Ogawa Mana, Kim Andrew T, Yahiro Ryosuke, Kure Yusuke, Yamaguchi Tomohiro, Okai Tsukasa, Takahashi Yosuke, Shibata Toshihiko, Yoshiyama Minoru
Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, 1-4-3, Asahimachi, Abenoku, Osaka, 545-8585, Japan.
Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.
Int J Cardiovasc Imaging. 2022 Jul;38(7):1463-1471. doi: 10.1007/s10554-022-02538-7. Epub 2022 Feb 8.
In patients with symptomatic severe aortic stenosis (AS), those who experienced readmission due to heart failure after transcatheter aortic valve replacement (TAVR) showed poor prognosis. Furthermore, poor B-type natriuretic peptide (BNP) improvement is associated with increased morbidity and mortality. However, little is known about the clinical parameters related to the change in BNP levels after TAVR procedure. This study population consisted of 127 consecutive patients of symptomatic severe AS with preserved ejection fraction (EF) who underwent transfemoral TAVR (TF-TAVR). Comprehensive transthoracic echocardiography was performed prior to the day of TF-TAVR. BNP was measured serially before and 1 year after TF-TAVR. The median BNP level was significantly decreased from 252.5 pg/ml to 146.8 pg/ml in all 127 patients 1 year after TF-TAVR (P < 0.01). However, the patients could be divided into 2 groups according to decrease (72%) or increase (28%) in plasma BNP level. Multivariate logistic regression analysis revealed that Aortic valve (AV) peak velocity, pre-procedural BNP, and larger left atrial volume index (LAVI) were found to be an independent predictor of increased BNP level 1 year after TAVR (OR 0.55, 95% CI 0.38-0.77; P < 0.01). LAVI were negatively correlated with the change in BNP level before and 1 year after TAVR (r = 0.47, P < 0.01). The ROC analysis demonstrated that 52.9 ml/m was the optimal cut-off value of LAVI for decreasing BNP 1 year after TAVR (area under the curve 0.69) with 64% sensitivity and 70% specificity. In addition to AV peak velocity and pre-procedural BNP, LAVI independently predicts future improvement of BNP levels 1 year after TAVR. Our findings indicate an additive predictive value of assessment of LAVI before TAVR procedure for risk stratification.
在有症状的严重主动脉瓣狭窄（AS）患者中，经导管主动脉瓣置换术（TAVR）后因心力衰竭再次入院的患者预后较差。此外，B型利钠肽（BNP）改善不佳与发病率和死亡率增加相关。然而，关于TAVR术后与BNP水平变化相关的临床参数知之甚少。本研究人群包括127例连续的有症状严重AS且射血分数（EF）保留的患者，他们接受了经股动脉TAVR（TF-TAVR）。在TF-TAVR当天之前进行了全面的经胸超声心动图检查。在TF-TAVR前后连续测量BNP。在所有127例患者中，TF-TAVR术后1年，BNP中位数水平从252.5 pg/ml显著降至146.8 pg/ml（P<0.01）。然而，根据血浆BNP水平降低（72%）或升高（28%），患者可分为两组。多因素逻辑回归分析显示，主动脉瓣（AV）峰值速度、术前BNP和较大的左心房容积指数（LAVI）是TAVR术后1年BNP水平升高的独立预测因素（OR 0.55，95%CI 0.38-0.77；P<0.01）。LAVI与TAVR前后BNP水平变化呈负相关（r=0.47，P<0.01）。ROC分析表明，52.9 ml/m²是TAVR术后1年BNP降低的LAVI最佳截断值（曲线下面积0.69），敏感性为64%，特异性为70%。除了AV峰值速度和术前BNP外，LAVI可独立预测TAVR术后1年BNP水平的未来改善情况。我们的研究结果表明，TAVR术前评估LAVI对风险分层具有附加预测价值。
