多模态研究中经导管主动脉瓣植入术后左心房应变对解剖和功能逆向重构的预测价值
The Predictive Value of Left Atrial Strain Following Transcatheter Aortic Valve Implantation on Anatomical and Functional Reverse Remodeling in a Multi-Modality Study.
作者信息
Vattay Borbála, Nagy Anikó Ilona, Apor Astrid, Kolossváry Márton, Manouras Aristomenis, Vecsey-Nagy Milán, Molnár Levente, Boussoussou Melinda, Bartykowszki Andrea, Jermendy Ádám L, Kováts Tímea, Zsarnóczay Emese, Maurovich-Horvat Pál, Merkely Béla, Szilveszter Bálint
机构信息
Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary.
Heart and Vascular Center, Semmelweis University, Budapest, Hungary.
出版信息
Front Cardiovasc Med. 2022 Apr 25;9:841658. doi: 10.3389/fcvm.2022.841658. eCollection 2022.
INTRODUCTION
Transcatheter aortic valve implantation (TAVI) can improve left ventricular (LV) mechanics and survival. Data on the predictive value of left atrial (LA) strain following TAVI are scarce. We aimed to evaluate the association of LA strain measured shortly post-TAVI with functional and anatomical reverse remodeling of the LA and LV, and its association with mortality.
METHODS
We prospectively investigated 90 patients who underwent TAVI. Transthoracic echocardiography including strain analysis was performed shortly after TAVI and repeated 6 months later. CT angiography (CTA) was performed for pre-TAVI planning and 6 months post-TAVI. Speckle tracking echocardiography was used to determine LA peak reservoir strain (LASr) and LV global longitudinal strain (LV-GL), LA volume index (LAVi) was measured by TTE. LV mass index (LVMi) was calculated using CTA images. LA reverse remodeling was based on LASr and LAVi changes, whereas LV reverse remodeling was defined as an improvement in LV-GLS or a reduction of LVMi. The association of severely reduced LASr (<20%) at baseline with changes (Δ) in LASr, LAVi, LV-GLS and LVMi were analyzed using linear regression, and Cox proportional hazard model for mortality.
RESULTS
Mean LASr and LV-GLS were 17.7 ± 8.4 and -15.3 ± 3.4% at baseline and 20.2 ± 10.2 and -16.6 ± 4.0% at follow-up ( = 0.024 and < 0.001, respectively). Severely reduced LASr at baseline was associated with more pronounced ΔLASr (β = 5.24, = 0.025) and LVMi reduction on follow-up (β = 5.78, = 0.036), however, the majority of the patients had <20% LASr on follow-up (44.4%). Also, ΔLASr was associated with ΔLV-GLS (adjusted β = 2.10, < 0.001). No significant difference in survival was found between patients with baseline severely reduced LASr (<20%) and higher LASr (≥20%) ( = 0.054).
CONCLUSION
LV reverse remodeling based on LVMi was present even in patients with severely reduced LASr following TAVI, although extensive LA damage based on LA strain was demonstrated by its limited improvement over time.
CLINICAL TRIAL REGISTRATION
(ClinicalTrials.gov number: NCT02826200).
引言
经导管主动脉瓣植入术（TAVI）可改善左心室（LV）力学功能并提高生存率。关于TAVI后左心房（LA）应变预测价值的数据较少。我们旨在评估TAVI后短期内测量的LA应变与LA和LV的功能及解剖学逆向重构之间的关联，及其与死亡率的关联。
方法
我们前瞻性地研究了90例行TAVI的患者。在TAVI后不久进行包括应变分析的经胸超声心动图检查，并在6个月后重复检查。在TAVI术前规划时和TAVI术后6个月进行CT血管造影（CTA）。使用斑点追踪超声心动图确定LA峰值储备应变（LASr）和LV整体纵向应变（LV-GL），通过经胸超声心动图测量LA容积指数（LAVi）。使用CTA图像计算LV质量指数（LVMi）。LA逆向重构基于LASr和LAVi的变化，而LV逆向重构定义为LV-GLS的改善或LVMi的降低。使用线性回归分析基线时严重降低的LASr（<20%）与LASr、LAVi、LV-GLS和LVMi变化（Δ）之间的关联，并使用Cox比例风险模型分析死亡率。
结果
基线时LASr和LV-GLS的平均值分别为17.7±8.4%和-15.3±3.4%，随访时分别为20.2±10.2%和-16.6±4.0%（分别为P = 0.024和P<0.001）。基线时严重降低的LASr与随访时更明显的ΔLASr（β = 5.24，P = 0.025）和LVMi降低相关（β = 5.78，P = 0.036），然而，大多数患者随访时LASr<20%（44.4%）。此外，ΔLASr与ΔLV-GLS相关（调整后β = 2.10，P<0.001）。基线时LASr严重降低（<20%）的患者与LASr较高（≥20%）的患者在生存率上无显著差异（P = 0.054）。
结论
尽管基于LA应变显示LA损伤随时间改善有限，但即使在TAVI后LASr严重降低的患者中也存在基于LVMi的LV逆向重构。
临床试验注册
（ClinicalTrials.gov编号：NCT02826200）
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