Department of Medicine II, Heart Center, University Hospital Bonn, Bonn, Germany.
Department of Cardiology, Heart Center, University Hospital Düsseldorf, Düsseldorf, Germany.
Catheter Cardiovasc Interv. 2022 Nov;100(5):850-859. doi: 10.1002/ccd.30368. Epub 2022 Aug 21.
A significant number of patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR) suffer from extra-aortic cardiac damage. Few studies have investigated strategies to quantify cardiac damage and stratify patients accordingly in different risk groups. The aim of this retrospective multicenter study was to provide a user-friendly simplified staging system based on the proposed classification system of Généreux et al. as a tool to evaluate the prognosis of patients undergoing TAVR more easily. Moreover, we analyzed changes in cardiac damage after TAVR.
We assessed cardiac damage in patients, who underwent TAVR at the Heart Center Bonn or Düsseldorf, using pre- and postprocedural transthoracic echocardiography. Patients were assigned to the staging system proposed by Généreux et al. according to the severity of their baseline cardiac damage. Based on the established system, we created a simplified staging system to facilitate improved applicability. Finally, we compared clinical outcomes between the groups and evaluated changes in cardiac damage after TAVR.
A total of 933 TAVR patients were included in the study. We found a significant association between cardiac damage and 1-year all-cause mortality (stage 0: 0% vs. stage 1: 3% vs. stage 2: 6.6%; p < 0.009). In multivariate analysis, cardiac damage was an independent predictor of 1-year all-cause mortality (hazard ratio: 2.0, 95% confidence interval: 1.1-3.8; p = 0.03).
In patients undergoing TAVR, cardiac damage is associated with enhanced mortality. A simplified staging system can help identify patients at high risk for an adverse outcome.
许多接受经导管主动脉瓣置换术（TAVR）的严重主动脉瓣狭窄（AS）患者存在主动脉外心脏损伤。很少有研究探讨量化心脏损伤并根据不同风险组对患者进行分层的策略。本回顾性多中心研究的目的是提供一种基于 Généreux 等人提出的分类系统的简单易用的简化分期系统，作为一种更轻松地评估 TAVR 患者预后的工具。此外，我们分析了 TAVR 后心脏损伤的变化。
我们使用术前和术后经胸超声心动图评估在波恩或杜塞尔多夫心脏中心接受 TAVR 的患者的心脏损伤。根据基线心脏损伤的严重程度，患者被分配到 Généreux 等人提出的分期系统。基于既定系统，我们创建了一个简化的分期系统，以提高适用性。最后，我们比较了各组之间的临床结果，并评估了 TAVR 后心脏损伤的变化。
共有 933 名接受 TAVR 的患者纳入研究。我们发现心脏损伤与 1 年全因死亡率之间存在显著相关性（0 期：0% vs. 1 期：3% vs. 2 期：6.6%；p < 0.009）。在多变量分析中，心脏损伤是 1 年全因死亡率的独立预测因素（危险比：2.0，95%置信区间：1.1-3.8；p = 0.03）。
在接受 TAVR 的患者中，心脏损伤与死亡率增加相关。简化的分期系统可以帮助识别高风险不良预后的患者。
