Castelo Alexandra, Grazina André, Mendonça Tiago, Rodrigues Inês, Brás Pedro Garcia, Ferreira Vera Vaz, Ramos Rúben, Fiarresga António, Cacela Duarte, Ferreira Rui Cruz
Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal.
Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal.
Rev Port Cardiol. 2022 Aug;41(8):621-631. doi: 10.1016/j.repc.2022.03.002. Epub 2022 Jun 22.
Some studies suggest that patients with low flow low gradient (LF-LG) aortic stenosis (AS) may achieve worse results after undergoing transcatheter aortic valve implantation (TAVI).
To compare outcomes between LF-LG AS and high gradient (HG) AS patients submitted to TAVI.
Inclusion of 480 consecutive patients who underwent TAVI between 2008 and 2020 at a single tertiary center. Patients were divided into high gradient AS and LF-LG AS; and baseline characteristics and outcomes after the procedure were collected and compared between groups.
Patients with LF-LG AS had worse baseline characteristics, with higher Society of Thoracic Surgeons score (p=0.008), New Euroscore II (p<0.0001), and NT pro-natriuretic peptide B (p=0.001), more frequent left ventricular ejection fraction (LVEF) <40% (p<0.0001), coronary artery disease (p<0.0001), including previous myocardial infarction (p=0.002) and coronary artery bypass graft (p<0.0001), poor vascular accesses (p=0.026) and periprocedural angioplasty (p=0.038). In a multivariate analysis, adjusted to differences in baseline characteristics, LF-LG AS was associated with worse functional class at one year (p=0.023) and in the long-term (p=0.004) and with heart failure hospitalizations at one year and in the long-term (p=0.001 and p<0.0001). In a sub-analysis including only patients with LF-LG AS, those with LVEF <40% had the worst outcomes, with more global (p=0.035) and cardiovascular (p=0.038) mortality.
Patients with LF-LG AS have worse short and long-term outcomes, even when adjusted for baseline characteristic differences. The sub-group of patients with LVEF <40% have the most ominous global outcomes.
一些研究表明，低流量低梯度（LF-LG）主动脉瓣狭窄（AS）患者在接受经导管主动脉瓣植入术（TAVI）后可能会有更差的结果。
比较接受TAVI的LF-LG AS患者和高梯度（HG）AS患者的结局。
纳入2008年至2020年在单一三级中心接受TAVI的480例连续患者。患者分为高梯度AS组和LF-LG AS组；收集两组患者的基线特征和术后结局并进行比较。
LF-LG AS患者的基线特征更差，胸外科医师协会评分更高（p = 0.008），欧洲心脏手术风险评估系统Ⅱ（p < 0.0001）和N末端B型利钠肽原（p = 0.001）更高，左心室射血分数（LVEF）<40%更常见（p < 0.0001），冠状动脉疾病更常见（p < 0.0001），包括既往心肌梗死（p = 0.002）和冠状动脉旁路移植术（p < 0.0001），血管入路不佳（p = 0.026）和围手术期血管成形术（p = 0.038）。在多变量分析中，校正基线特征差异后，LF-LG AS与1年时（p = 0.023）和长期（p = 0.004）较差的功能分级以及1年时和长期的心力衰竭住院相关（p = 0.001和p < 0.0001）。在仅包括LF-LG AS患者的亚分析中，LVEF < 40%的患者结局最差，全因死亡率（p = 0.035）和心血管死亡率（p = 0.038）更高。
LF-LG AS患者的短期和长期结局更差，即使校正了基线特征差异。LVEF < 40%的患者亚组的全因结局最凶险。
