Bäz Laura, Möbius-Winkler Sven, Diab Mahmoud, Kräplin Thomas, Westphal Julian G, Ibrahim Karim, Schulze P Christian, Franz Marcus
Department of Internal Medicine I, University Hospital Jena, Jena, Germany.
Research Program "Else Kröner-Forschungskolleg AntiAge", Jena University Hospital, Jena, Germany.
Front Cardiovasc Med. 2023 Feb 16;10:990373. doi: 10.3389/fcvm.2023.990373. eCollection 2023.
In patients with aortic stenosis treated by transcatheter aortic valve implantation (TAVI), mitral and tricuspid regurgitation (MR and TR) at baseline and after TAVI are likely to be of prognostic relevance, and questions such as whether and when treatment further improves prognosis in these patients arise.
Against that background, the purpose of this study was to analyze a variety of clinical characteristics including MR and TR with respect to their potential value as predictors of 2-year mortality after TAVI.
A cohort of 445 typical TAVI patients was available for the study and clinical characteristics were evaluated baseline, 6 to 8 weeks as well as 6 months after TAVI.
In 39% of the patients relevant (moderate or severe) MR and in 32% of the patients relevant (moderate or severe) TR could be detected at baseline. The rates were 27% for MR ( = 0.001, compared to baseline) and 35% for TR ( = n.s., compared to baseline) at the 6- to 8-week follow-up. After 6 months, relevant MR was observable in 28% ( = 0.036, compared to baseline) and relevant TR in 34% ( = n.s., compared to baseline) of the patients. As predictors of 2-year mortality, a multivariate analysis identified the following parameters for the different time points: sex, age, AS entity, atrial fibrillation, renal function, relevant TR, systolic pulmonary artery pressure (PAPsys), and 6-min walk distance at baseline; clinical frailty scale and PAPsys 6-8 weeks after TAVI and BNP and relevant MR 6 months after TAVI. There was a significantly worse 2-year survival in patients with relevant TR at baseline (68.4% vs. 82.6%, < 0.001; whole population, = 445) and in patients with relevant MR at 6 months (87.9% vs. 95.2%, = 0.042; landmark analysis: = 235).
This real-life study demonstrated the prognostic relevance of repeated evaluation of MR and TR before and after TAVI. Choosing the right time point for treatment is a remaining clinical challenge, which should be further addressed in randomized trials.
在接受经导管主动脉瓣植入术（TAVI）治疗的主动脉瓣狭窄患者中，基线时以及TAVI术后的二尖瓣和三尖瓣反流（MR和TR）可能具有预后相关性，于是出现了诸如这种治疗是否以及何时能进一步改善这些患者预后的问题。
在此背景下，本研究的目的是分析包括MR和TR在内的各种临床特征，以探讨其作为TAVI术后2年死亡率预测指标的潜在价值。
本研究纳入了445例接受典型TAVI治疗的患者，并在基线、TAVI术后6至8周以及6个月时评估其临床特征。
在39%的患者中，基线时可检测到相关（中度或重度）MR，在32%的患者中可检测到相关（中度或重度）TR。在6至8周的随访中，MR的发生率为27%（与基线相比，P<0.001），TR的发生率为35%（与基线相比，P=无统计学意义）。6个月后，28%的患者可观察到相关MR（与基线相比，P=0.036），34%的患者可观察到相关TR（与基线相比，P=无统计学意义）。作为2年死亡率的预测指标，多因素分析确定了不同时间点的以下参数：基线时的性别、年龄、AS类型、心房颤动、肾功能、相关TR、收缩期肺动脉压（PAPsys）和6分钟步行距离；TAVI术后6至8周的临床衰弱量表和PAPsys，以及TAVI术后6个月的BNP和相关MR。基线时存在相关TR的患者2年生存率显著更差（68.4%对82.6%，P<0.001；总体人群，n=445），6个月时存在相关MR的患者2年生存率也显著更差（87.9%对95.2%，P=0.042；标志性分析：n=235）。
这项真实世界研究证明了TAVI术前和术后重复评估MR和TR的预后相关性。选择合适的治疗时间点仍然是一项临床挑战，应在随机试验中进一步探讨。
