Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland.
Institute of Social and Preventive Medicine and Clinical Trials Unit, University of Bern, Bern, Switzerland.
Catheter Cardiovasc Interv. 2022 May;99(6):1908-1917. doi: 10.1002/ccd.30132. Epub 2022 Feb 16.
Increased left ventricular afterload resulting from severe aortic stenosis (AS) leads to progressive cardiac remodeling. Left atrial enlargement (LAE) is an early manifestation in a series of maladaptive changes and may affect clinical outcomes after valvular replacement therapy. The aim of this study is to determine the impact of LAE on clinical outcomes in symptomatic patients with severe AS undergoing transcatheter aortic valve implantation (TAVI).
In a prospective single-center TAVI registry, we analyzed LA dimensions measured by echocardiography before intervention. Patients with atrial fibrillation or concomitant mitral valve disease were excluded. LAE was defined as indexed LA volume >34 ml/m . The primary endpoint was cardiovascular death (CVD) at 1 year.
Among 1663 patients undergoing TAVI between August 2007 and December 2016, 768 (46.2%) were eligible for the present analysis and 486 patients had LAE. The prevalence of LAE was higher in males (68.3%) as compared to females (58.8%). Patients with LAE were older (82.3 ± 6.7 years vs. 80.0 ± 6.4 years) and had a higher STS-PROM score (6.1 ± 4.7% vs. 4.7 ± 2.9%). After adjustment, patients with LAE had an increased risk of CVD at 1-year compared to patients with normal LA dimensions (49 [10.4%] vs. 8 [2.9%]; HR , 3.52; 95% CI, 1.66-7.44)]. In multivariable analysis, LAE was independently associated with an increased risk of CVD at 1-year (HR , 3.52; 95% CI, 1.66-7.44).
LAE secondary to AS was documented in a significant proportion of patients undergoing TAVI and was associated with a more than threefold increased risk of CVD at 1-year.
严重主动脉瓣狭窄（AS）导致的左心室后负荷增加可导致进行性心脏重构。左心房扩大（LAE）是一系列适应性不良变化中的早期表现，可能会影响瓣膜置换术后的临床结果。本研究旨在确定 LAE 对接受经导管主动脉瓣植入术（TAVI）的有症状重度 AS 患者临床结果的影响。
在一项前瞻性单中心 TAVI 注册研究中，我们分析了介入前超声心动图测量的 LA 尺寸。排除心房颤动或合并二尖瓣疾病的患者。LAE 定义为指数化 LA 容积>34ml/m。主要终点为 1 年时心血管死亡（CVD）。
在 2007 年 8 月至 2016 年 12 月期间接受 TAVI 的 1663 例患者中，有 768 例（46.2%）符合本研究的条件，其中 486 例有 LAE。LAE 的患病率在男性（68.3%）高于女性（58.8%）。LAE 患者年龄较大（82.3±6.7 岁 vs. 80.0±6.4 岁），STS-PROM 评分较高（6.1±4.7% vs. 4.7±2.9%）。调整后，与 LA 正常尺寸的患者相比，LAE 患者 1 年时 CVD 的风险增加（49[10.4%]vs.8[2.9%]；HR，3.52；95%CI，1.66-7.44]）。多变量分析显示，LAE 是 1 年 CVD 风险增加的独立危险因素（HR，3.52；95%CI，1.66-7.44）。
在接受 TAVI 的患者中，AS 导致的 LAE 占很大比例，与 1 年 CVD 风险增加超过三倍相关。
