经导管主动脉瓣置换术后肺动脉高压对预后的影响。
Impact of Periprocedural Pulmonary Hypertension on Outcomes After Transcatheter Aortic Valve Replacement.
机构信息
Department of Cardiology, Tokai University, Isehara, Japan.
Department of Cardiology, Tokai University, Isehara, Japan.
出版信息
J Am Coll Cardiol. 2022 Oct 25;80(17):1601-1613. doi: 10.1016/j.jacc.2022.08.757.
BACKGROUND
There are limited data on the prognostic impact of periprocedural pulmonary hypertension (PH) after transcatheter aortic valve replacement (TAVR).
OBJECTIVES
The aim of this study was to investigate the prognostic impact of normalized, new-onset, and residual PH after TAVR.
METHODS
The OCEAN-TAVI (Optimized Transcatheter Valvular Intervention-Transcatheter Aortic Valve Implantation) registry is an ongoing, multicenter Japanese registry that includes 2,588 patients who underwent TAVR. Patients were classified into 4 groups according to periprocedural systolic pulmonary artery pressure by echocardiography: no PH before and after TAVR (no PH), PH before but not after TAVR (normalized PH), PH after but not before TAVR (new-onset PH), and PH before and after TAVR (residual PH). A systolic pulmonary artery pressure cutoff of >36 mm Hg was applied for PH. The primary endpoint was all-cause mortality at 2 years. Logistic regression analysis was used to identify clinical predictors of residual and new-onset PH.
RESULTS
In total, 1,872 patients were divided into 4 groups: 1,027 (54.9%) in the no PH group, 257 (13.7%) in the normalized PH group, 280 (15.0%) in the new-onset PH group, and 308 (16.5%) in the residual PH group. There was a significant difference in all-cause mortality among the 4 groups at 2 years (11.0%, 12.8%, 18.6%, and 24.7%, respectively; P < 0.01). Among 565 patients who had preprocedural PH, 257 (45.5%) experienced normalization of PH, with mortality comparable with that in the no PH group. In multivariable logistic regression analysis, predictors of residual PH after TAVR were atrial fibrillation and baseline tricuspid regurgitation moderate or greater, whereas prosthesis-patient mismatch was a predictor of new-onset PH.
CONCLUSIONS
Risk stratification on the basis of post-TAVR PH status can identify patients at increased mortality after TAVR. Prosthesis-patient mismatch was identified as a novel predictor of new-onset PH. (Optimized Transcatheter Valvular Intervention-Transcatheter Aortic Valve Implantation [OCEAN-TAVI]; UMIN000020423).
背景
经导管主动脉瓣置换术（TAVR）后围手术期肺动脉高压（PH）的预后影响数据有限。
目的
本研究旨在探讨 TAVR 后正常化、新发和残留 PH 的预后影响。
方法
OCEAN-TAVI（优化经导管瓣膜介入-经导管主动脉瓣植入）注册研究是一项正在进行的多中心日本注册研究，纳入了 2588 例接受 TAVR 的患者。根据超声心动图检查的围手术期收缩期肺动脉压，患者被分为 4 组：TAVR 前后均无 PH（无 PH）、TAVR 前有 PH 但 TAVR 后无 PH（正常化 PH）、TAVR 后有 PH 但 TAVR 前无 PH（新发 PH）和 TAVR 前后均有 PH（残留 PH）。PH 采用收缩期肺动脉压>36mmHg 作为截断值。主要终点是 2 年全因死亡率。采用 logistic 回归分析确定残留和新发 PH 的临床预测因素。
结果
共纳入 1872 例患者，分为 4 组：无 PH 组 1027 例（54.9%），正常化 PH 组 257 例（13.7%），新发 PH 组 280 例（15.0%），残留 PH 组 308 例（16.5%）。4 组 2 年全因死亡率有显著差异（分别为 11.0%、12.8%、18.6%和 24.7%；P<0.01）。在 565 例术前有 PH 的患者中，257 例（45.5%）PH 正常化，死亡率与无 PH 组相当。多变量 logistic 回归分析显示，TAVR 后残留 PH 的预测因素为心房颤动和基线三尖瓣反流中度或以上，而瓣-患者不匹配是新发 PH 的预测因素。
结论
基于 TAVR 后 PH 状态的风险分层可以识别 TAVR 后死亡率增加的患者。瓣-患者不匹配被确定为新发 PH 的新预测因素。（优化经导管瓣膜介入-经导管主动脉瓣植入[OCEAN-TAVI]；UMIN000020423）。
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