经导管主动脉瓣置换术后左心室肥厚对心血管结局的预测作用。
Left ventricular hypertrophy as a predictor of cardiovascular outcomes after transcatheter aortic valve replacement.
机构信息
Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Department of Cardiovascular Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
出版信息
ESC Heart Fail. 2023 Apr;10(2):1336-1346. doi: 10.1002/ehf2.14305. Epub 2023 Feb 1.
AIMS
This study aimed to clarify the relationship between cardiovascular prognosis and left ventricular hypertrophy (LVH) in patients with severe aortic stenosis who underwent transcatheter aortic valve replacement (TAVR) and to investigate the relationship between cardiac sympathetic nerve (CSN) function and these factors using I-metaiodobenzylguanidine scintigraphy.
METHODS AND RESULTS
In this single-centre, retrospective observational study, 349 patients who underwent TAVR at our institution between July 2017 and May 2020 were divided into two groups: those with severe LVH pre-operatively [severe LVH (+) group] and those without LVH pre-operatively [severe LVH (-) group]. The rates of freedom from cardiovascular events (cardiovascular death and heart failure hospitalization) were compared. The relationship between changes in left ventricular mass index (LVMi) and changes in delay heart-mediastinum ratio (H/M) from before TAVR to 6 months after TAVR was also investigated. The event-free rate was significantly lower in the severe LVH (+) group (87.1% vs. 96.0%, log-rank P = 0.021). The severe LVH (+) group exhibited a significantly lower delay H/M value, scored by I-metaiodobenzylguanidine scintigraphy, than the severe LVH (-) group (2.33 [1.92-2.67] vs. 2.67 [2.17-3.68], respectively, P < 0.001). Moreover, the event-free rate of post-operative cardiovascular events was lower among patients with a delay H/M value < 2.50 than that among other patients (87.7% vs. 97.2%, log-rank P = 0.012). LVMi was significantly higher (115 [99-130] vs. 90 [78-111] g/m , P < 0.001) and delay H/M value was significantly lower (2.53 [1.98-2.83] vs. 2.71 [2.25-3.19], P = 0.025) in the severe LVH (+) group than in the severe LVH (-) group at 6 months after TAVR. Patients with improved LVH at 6 months after TAVR also had increased delay H/M (from 2.51 [2.01-2.81] to 2.67 [2.26-3.02], P < 0.001), whereas those without improved LVH had no significant change in delay H/M (from 2.64 [2.23-3.06] to 2.53 [1.97-3.00], P = 0.829).
CONCLUSIONS
Severe LVH before TAVR is a prognostic factor for poor post-operative cardiovascular outcomes. LVH associated with aortic stenosis and CSN function are correlated, suggesting their involvement in LVH prognosis.
目的
本研究旨在阐明行经导管主动脉瓣置换术（TAVR）的重度主动脉瓣狭窄患者的心血管预后与左心室肥厚（LVH）之间的关系，并通过碘-间位碘苄胍闪烁显像术探讨心脏交感神经（CSN）功能与这些因素之间的关系。
方法和结果
在这项单中心回顾性观察研究中，我们将在我院于 2017 年 7 月至 2020 年 5 月期间接受 TAVR 的 349 例患者分为两组：术前存在严重 LVH（严重 LVH（+）组）和术前无 LVH（严重 LVH（-）组）。比较两组患者无心血管事件（心血管死亡和心力衰竭住院）的生存率。还研究了 TAVR 前和 TAVR 后 6 个月左心室质量指数（LVMi）变化与延迟心脏-纵隔比（H/M）变化之间的关系。严重 LVH（+）组的无事件生存率显著低于严重 LVH（-）组（87.1% vs. 96.0%，对数秩检验 P=0.021）。与严重 LVH（-）组相比，严重 LVH（+）组碘-间位碘苄胍闪烁显像术评估的延迟 H/M 值明显更低（2.33 [1.92-2.67] vs. 2.67 [2.17-3.68]，P<0.001）。此外，延迟 H/M 值<2.50 的患者术后心血管事件的无事件生存率低于其他患者（87.7% vs. 97.2%，对数秩检验 P=0.012）。TAVR 后 6 个月时，LVMi 明显更高（115 [99-130] vs. 90 [78-111] g/m ，P<0.001），延迟 H/M 值明显更低（2.53 [1.98-2.83] vs. 2.71 [2.25-3.19]，P=0.025），与严重 LVH（-）组相比，严重 LVH（+）组更明显。TAVR 后 6 个月时 LVH 改善的患者的延迟 H/M 也增加（从 2.51 [2.01-2.81] 到 2.67 [2.26-3.02]，P<0.001），而 LVH 未改善的患者延迟 H/M 无明显变化（从 2.64 [2.23-3.06] 到 2.53 [1.97-3.00]，P=0.829）。
结论
TAVR 前的严重 LVH 是术后心血管不良结局的预后因素。与主动脉瓣狭窄相关的 LVH 与 CSN 功能相关，表明它们参与 LVH 的预后。
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