Généreux Philippe, Cohen David J, Pibarot Philippe, Redfors Björn, Bax Jeroen J, Zhao Yanglu, Prince Heather, Makkar Raj R, Kapadia Samir, Thourani Vinod H, Mack Michael J, Nazif Tamim M, Lindman Brian R, Babaliaros Vasilis, Russo Mark, McCabe James M, Gillam Linda D, Alu Maria C, Hahn Rebecca T, Webb John G, Leon Martin B, Arnold Suzanne V
Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, New Jersey, USA.
Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA; St. Francis Hospital and Heart Center, Roslyn, New York, USA.
J Am Coll Cardiol. 2023 Feb 28;81(8):743-752. doi: 10.1016/j.jacc.2022.11.059.
The extent of extravalvular cardiac damage is associated with increased risk of adverse events among patients with severe aortic stenosis undergoing aortic valve replacement (AVR).
The goal was to describe the association of cardiac damage on health status before and after AVR.
Patients from the PARTNER (Placement of Aortic Transcatheter Valves) 2 and 3 trials were pooled and classified by echocardiographic cardiac damage stage at baseline and 1 year as previously described (stage 0-4). We examined the association between baseline cardiac damage and 1-year health status (assessed by the Kansas City Cardiomyopathy Questionnaire Overall Score [KCCQ-OS]).
Among 1,974 patients (794 surgical AVR, 1,180 transcatheter AVR), the extent of cardiac damage at baseline was associated with lower KCCQ scores both at baseline and at 1 year after AVR (P < 0.0001) and with increased rates of a poor outcome (death, KCCQ-OS <60, or a decrease in KCCQ-OS of ≥10 points) at 1 year (stages 0-4: 10.6% vs 19.6% vs 29.0% vs 44.7% vs 39.8%; P < 0.0001). In a multivariable model, each 1-stage increase in baseline cardiac damage was associated with a 24% increase in the odds of a poor outcome (95% CI: 9%-41%; P = 0.001). Change in stage of cardiac damage at 1 year after AVR was associated with the extent of improvement in KCCQ-OS over the same period (mean change in 1-year KCCQ-OS: improvement of ≥1 stage +26.8 [95% CI: 24.2-29.4] vs no change +21.4 [95% CI: 20.0-22.7] vs deterioration of ≥1 stage +17.5 [95% CI: 15.4-19.5]; P < 0.0001).
The extent of cardiac damage before AVR has an important impact on health status outcomes, both cross-sectionally and after AVR. (PARTNER II Trial: Placement of AoRTic TraNscathetER Valves II - XT Intermediate and High Risk (PII A), NCT01314313; The PARTNER II Trial: Placement of AoRTic TraNscathetER Valves - PII B [PARTNERII B], NCT02184442; PARTNER 3 Trial: Safety and Effectiveness of the SAPIEN 3 Transcatheter Heart Valve in Low Risk Patients With Aortic Stenosis [P3], NCT02675114).
在接受主动脉瓣置换术（AVR）的严重主动脉瓣狭窄患者中，瓣膜外心脏损伤的程度与不良事件风险增加相关。
目的是描述心脏损伤与AVR前后健康状况之间的关联。
汇总来自PARTNER（主动脉经导管瓣膜置入）2和3试验的患者，并按照之前描述的方法，根据基线和1年时的超声心动图心脏损伤阶段进行分类（0-4期）。我们研究了基线心脏损伤与1年时健康状况之间的关联（通过堪萨斯城心肌病问卷总体评分[KCCQ-OS]评估）。
在1974例患者中（794例行外科AVR，1180例行经导管AVR），基线时心脏损伤的程度与基线时以及AVR后1年时较低的KCCQ评分相关（P<0.0001），并且与1年时不良结局（死亡、KCCQ-OS<60或KCCQ-OS降低≥10分）的发生率增加相关（0-4期：10.6%对19.6%对29.0%对44.7%对39.8%；P<0.0001）。在多变量模型中，基线心脏损伤每增加1期，不良结局的几率增加24%（95%CI：9%-41%；P=0.001）。AVR后1年时心脏损伤阶段的变化与同期KCCQ-OS的改善程度相关（1年时KCCQ-OS的平均变化：改善≥1期+26.8[95%CI：24.2-29.4]对无变化+21.4[95%CI：20.0-22.7]对恶化≥1期+17.5[95%CI：15.4-19.5]；P<0.0001）。
AVR前心脏损伤的程度对健康状况结局有重要影响，无论是横断面还是AVR后。（PARTNER II试验：主动脉经导管瓣膜置入II - XT中高危（PII A），NCT01314313；PARTNER II试验：主动脉经导管瓣膜置入 - PII B[PARTNERII B]，NCT02184442；PARTNER 3试验：SAPIEN 3经导管心脏瓣膜在低风险主动脉瓣狭窄患者中的安全性和有效性[P3]，NCT02675114）
