Heart Centre Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany.
Heart Centre Cologne, Department of Cardiology, University Hospital Cologne, Cologne, Germany.
Hellenic J Cardiol. 2023 Nov-Dec;74:1-7. doi: 10.1016/j.hjc.2023.04.009. Epub 2023 Apr 27.
Left ventricular reverse remodeling (LVRR) is associated with improved outcome in patients with heart failure. Factors associated with and predictive of LVRR in patients with low-flow low-gradient aortic stenosis (LFLG AS) after transcatheter aortic valve implantation (TAVI) and its impact on outcome were assessed.
Pre- and postprocedural left ventricular (LV) function and volume were investigated in 219 patients with LFLG. LVRR was defined as an absolute increase of ≥10% in LV ejection fraction (LVEF) and reduction of ≥15% in LV end-systolic volume (LVESV). The primary endpoint was the combination of all-cause mortality and rehospitalization for heart failure.
The mean LVEF was 35.0 ± 10.0%, with a stroke volume index (SVI) of 25.9 ± 6.0 mL/m and LVESV of 94.04 ± 46.0 mL. At a median of 5.2 months (interquartile range, 2.7-8.1 months), 77.2% (n = 169) of the patients showed echocardiographic evidence of LVRR. A multivariate model revealed three independent factors for LVRR after TAVI: SVI of <25 mL/m (hazard ratio [HR], 2.31; 95% confidence interval [CI], 1.08-3.58; p < 0.01), LVEF of <30% (HR, 2.76; 95% CI, 1.53-2.91; p < 0.01), and valvulo-arterial impedance (Z) of <5 mmHg/mL/m (HR, 5.36; 95% CI, 1.80-15.98; p < 0.01). Patients without evidence of LVRR showed a significantly higher incidence of the 1-year combined endpoint (32 [64.0%] vs. 75 [44.4%], p < 0.01).
The majority of patients with LFLG AS show LVRR after TAVI, which is associated with favorable outcomes. An SVI of <25 mL/m, LVEF of <30%, and Z < 5mmHg/mL/m represent predictors of LVRR.
左心室逆向重构（LVRR）与心力衰竭患者的预后改善相关。本研究评估了经导管主动脉瓣置换术（TAVI）后低流量低梯度主动脉瓣狭窄（LFLG AS）患者的 LVRR 相关因素及其预测因素，并分析了其对预后的影响。
对 219 例 LFLG 患者进行术前和术后左心室（LV）功能和容量检查。LVRR 定义为 LV 射血分数（LVEF）绝对增加≥10%和 LV 收缩末期容积（LVESV）减少≥15%。主要终点是全因死亡率和因心力衰竭再住院的联合终点。
平均 LVEF 为 35.0±10.0%，SV 指数（SVI）为 25.9±6.0mL/m，LVESV 为 94.04±46.0mL。中位随访时间为 5.2 个月（四分位间距，2.7-8.1 个月），77.2%（n=169）的患者超声心动图表现出 LVRR。多变量模型显示 TAVI 后 LVRR 的三个独立因素为：SVI<25mL/m（危险比[HR]，2.31；95%置信区间[CI]，1.08-3.58；p<0.01），LVEF<30%（HR，2.76；95%CI，1.53-2.91；p<0.01），以及瓣膜-动脉阻抗（Z）<5mmHg/mL/m（HR，5.36；95%CI，1.80-15.98；p<0.01）。没有出现 LVRR 的患者，1 年联合终点的发生率明显更高（32[64.0%] vs. 75[44.4%]，p<0.01）。
大多数 LFLG AS 患者在 TAVI 后出现 LVRR，这与良好的预后相关。SVI<25mL/m、LVEF<30%和 Z<5mmHg/mL/m 是 LVRR 的预测因素。
