Shirakawa Kohsuke, Itabashi Yuji, Tsuruta Hikaru, Minakata Yugo, Hayashida Kentaro, Arai Takahide, Yanagisawa Ryo, Tanaka Makoto, Shimizu Hideyuki, Fukuda Keiichi, Murata Mitsushige
Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
Department of Cardiovascular Surgery, Keio University School of Medicine, Tokyo, Japan.
AsiaIntervention. 2019 Feb 20;5(1):72-80. doi: 10.4244/AIJ-D-18-00021. eCollection 2019 Feb.
Increased stroke volume (SV) is a prognosticator of severe aortic stenosis (AS) after transcatheter aortic valve replacement (TAVR). This study aimed to investigate preprocedural echocardiographic predictors of increased SV after TAVR.
Clinical and echocardiographic data were retrospectively analysed in 129 patients with severe AS who underwent TAVR (2013-2015). We compared the echocardiographic data and cardiac events between the decreased SV group (n=28) and the increased SV group (n=101). Univariate and multivariate analyses were used to assess the predictors of increasing SV. AS severity significantly diminished, left and right ventricular function improved, and SV index (SVi) increased after TAVR: aortic valve area index (0.46±0.13 vs. 1.18±0.33 cm2, p<0.001); aortic regurgitation (AR) grade (1.85±0.55 vs. 1.60±0.54, p<0.001); left ventricular ejection fraction (59.9±12.7 vs. 64.1±12.0%, p<0.001); right ventricular fractional area change (RVFAC) (48.8±11.9 vs. 53.3±14.0%, p<0.001); SV index (SVi) (46.7±11.0 vs. 52.8±12.0 ml/m2, p<0.001). Kaplan-Meier survival estimates suggested that the SVi increase was associated with the decreased cardiovascular events one year after TAVR (hazard ratio 4.08, 95% confidence interval [CI]: 1.32-12.7, p=0.02). On multivariate analysis, preprocedural AR grade (odds ratio [OR] 7.00, 95% CI: 2.76-17.8, p<0.001) and preprocedural RVFAC (OR 1.05, 95% CI: 1.01-1.10, p=0.011) correlated with the SV increase.
Preprocedurally, greater AR and higher RVFAC could predict an increased SVi and thus the occurrence of fewer cardiac events. Preserved preprocedural RV systolic function is crucial for an increased SV after TAVR.
在经导管主动脉瓣置换术（TAVR）后，每搏输出量（SV）增加是严重主动脉瓣狭窄（AS）的一个预后指标。本研究旨在探讨TAVR后SV增加的术前超声心动图预测指标。
对129例接受TAVR（2013 - 2015年）的严重AS患者的临床和超声心动图数据进行回顾性分析。我们比较了SV降低组（n = 28）和SV增加组（n = 101）的超声心动图数据及心脏事件。采用单因素和多因素分析来评估SV增加的预测指标。TAVR后AS严重程度显著减轻，左、右心室功能改善，SV指数（SVi）增加：主动脉瓣面积指数（0.46±0.13 vs. 1.18±0.33 cm²，p < 0.001）；主动脉瓣反流（AR）分级（1.85±0.55 vs. 1.60±0.54，p < 0.001）；左心室射血分数（59.9±12.7 vs. 64.1±12.0%，p < 0.001）；右心室面积变化分数（RVFAC）（48.8±11.9 vs. 53.3±14.0%，p < 0.001）；SV指数（SVi）（46.7±11.0 vs. 52.8±12.0 ml/m²，p < 0.001）。Kaplan - Meier生存估计表明，TAVR后1年SVi增加与心血管事件减少相关（风险比4.08，95%置信区间[CI]：1.32 - 12.7，p = 0.02）。多因素分析显示，术前AR分级（比值比[OR] 7.00，95% CI：2.76 - 17.8，p < 0.001）和术前RVFAC（OR 1.05，95% CI：1.01 - 1.10，p = 0.011）与SV增加相关。
术前，更大的AR和更高的RVFAC可预测SVi增加，从而心脏事件发生较少。术前保留右心室收缩功能对TAVR后SV增加至关重要。
