Ahmed Tarek A N, Ki You-Jeong, Choi You-Jung, El-Naggar Heba M, Kang Jeehoon, Han Jung-Kyu, Yang Han-Mo, Park Kyung Woo, Kang Hyun-Jae, Koo Bon-Kwon, Kim Hyo-Soo
Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea.
Department of Cardiovascular Medicine, Assiut University Heart Hospital, Assiut, Egypt.
Front Cardiovasc Med. 2022 Feb 9;8:746774. doi: 10.3389/fcvm.2021.746774. eCollection 2021.
Systemic inflammatory response syndrome (SIRS) is a systemic insult that has been described with many interventional cardiac procedures. The outcomes of patients undergoing transcatheter aortic valve implantation (TAVI) are thought to be influenced by this syndrome not only on short-term, but also on long-term.
We assessed the association of SIRS to different clinical, echocardiographic, and computed tomographic (CT) outcomes after TAVI.
Two hundred and twenty-four consecutive patients undergoing TAVI were enrolled in this study. They were assessed for the occurrence of SIRS within the first 48 h after TAVI. Patients were followed-up for short- and long-term clinical outcomes. Serial echocardiographic follow-ups were conducted at 1-week, 6-months, and 1-year. CT follow-up at 1 year was recorded.
Eighty patients (36%) developed SIRS. Among different parameters, only pre-TAVI total leucocytic count (TLC), pre-TAVI heart rate, and post-TAVI systolic blood pressure independently predicted the occurrence of SIRS. The incidence of HALT was not significantly different between both groups, albeit higher among SIRS patients ( = 0.1) at 1-year CT follow-up. Both groups had similar patterns of LV recovery on serial echocardiography. Long-term follow-up showed that all-cause death, cardiac death, and re-admission for heart failure (HF) or acute coronary syndrome (ACS) were significantly more frequent among SIRS patients. Early safety and clinical efficacy outcomes were more frequently encountered in the SIRS group, while device-related events and time-related valve safety were comparable.
Although SIRS implies an early acute inflammatory status post-TAVI, yet its clinical sequelae seem to extend to long-term clinical outcomes.
全身炎症反应综合征（SIRS）是一种全身性损伤，在许多心脏介入手术中都有描述。经导管主动脉瓣植入术（TAVI）患者的预后被认为不仅在短期，而且在长期都受到该综合征的影响。
我们评估了TAVI后SIRS与不同临床、超声心动图和计算机断层扫描（CT）结果之间的关联。
本研究纳入了224例连续接受TAVI的患者。在TAVI后48小时内评估他们是否发生SIRS。对患者进行短期和长期临床结果随访。在1周、6个月和1年进行系列超声心动图随访。记录1年时的CT随访情况。
80例患者（36%）发生了SIRS。在不同参数中，只有TAVI前的总白细胞计数（TLC）、TAVI前的心率和TAVI后的收缩压独立预测了SIRS的发生。两组之间HALT的发生率没有显著差异，尽管在1年CT随访时SIRS患者中的发生率更高（P = 0.1）。两组在系列超声心动图上的左心室恢复模式相似。长期随访显示，SIRS患者中全因死亡、心源性死亡以及因心力衰竭（HF）或急性冠状动脉综合征（ACS）再次入院的情况明显更频繁。SIRS组更频繁地出现早期安全性和临床疗效结果，而与器械相关的事件和与时间相关的瓣膜安全性相当。
尽管SIRS意味着TAVI后早期的急性炎症状态，但其临床后遗症似乎会延伸至长期临床结果。
