Heart, Vascular & Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
Open Heart. 2022 Jun;9(1). doi: 10.1136/openhrt-2022-002015.
Increase in left ventricular filling pressure (FP) and diastolic dysfunction are established consequences of progressive aortic stenosis (AS). However, the impact of elevated FP as detected by pretranscatheter aortic valve replacement (TAVR) echocardiogram on long-term outcomes after TAVR remains unclear.
To understand the impact of elevated FP in patients with severe AS who undergo TAVR.
This was a retrospective study of all patients who underwent TAVR between 1 January 2014 and 31 December 2017. The presence of elevated FP was determined in accordance with the latest guidelines using the last available comprehensive echocardiogram prior to TAVR.
Of 983 patients who were included in our study, 422 patients (43%) were found to have elevated FP and 561 patients (57%) had normal FP prior to TAVR. Patients with elevated FP had a mean age of 81.2±8.6 years and were more likely to be males (62%), diabetic (41% vs 35%, p=0.046), and have a higher prevalence of atrial fibrillation (Afib) (53% vs 39%, p<0.001). The 5-year all-cause mortality after TAVR was significantly higher in patients with elevated FP when compared with patients with normal FP (32% vs 24%, p=0.006). The presence of elevated FP, history of Afib and prior PCI emerged as independent predictors of long-term mortality after TAVR.
Elevated FP is associated with increased mortality in patients with severe AS undergoing TAVR. Assessment of FP should be incorporated into the risk assessment of AS patients to identify those who may benefit from early intervention.
左心室充盈压（FP）升高和舒张功能障碍是进行性主动脉瓣狭窄（AS）的既定后果。然而，经导管主动脉瓣置换术（TAVR）前超声心动图检测到的 FP 升高对 TAVR 后长期结局的影响尚不清楚。
了解行 TAVR 的重度 AS 患者中 FP 升高的影响。
这是一项回顾性研究，纳入了 2014 年 1 月 1 日至 2017 年 12 月 31 日期间行 TAVR 的所有患者。根据最新指南，使用 TAVR 前最后一次可用的综合超声心动图确定 FP 是否升高。
在纳入本研究的 983 例患者中，422 例（43%）患者存在 FP 升高，561 例（57%）患者 TAVR 前 FP 正常。FP 升高的患者平均年龄为 81.2±8.6 岁，更可能为男性（62%）、糖尿病（41%比 35%，p=0.046）和心房颤动（Afib）发生率更高（53%比 39%，p<0.001）。与 FP 正常的患者相比，FP 升高的患者 TAVR 后 5 年全因死亡率明显更高（32%比 24%，p=0.006）。FP 升高、Afib 病史和既往 PCI 是 TAVR 后长期死亡的独立预测因素。
FP 升高与重度 AS 行 TAVR 的患者死亡率增加相关。应将 FP 评估纳入 AS 患者的风险评估中，以识别那些可能从早期干预中获益的患者。
