Chao Chieh-Ju, Agasthi Pradyumna, Seri Amith R, Barry Timothy, Shanbhag Anusha, Wang Yuxiang, Eleid Mackram F, Fortuin David, Sweeney John P, Pollak Peter, El Sabbagh Abdallah, Lester Steven J, Freeman William K, Naqvi Tasneem Z, Holmes David R, Appleton Christopher P, Arsanjani Reza
Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ 85259, USA.
Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, MN 55905, USA.
J Cardiovasc Dev Dis. 2023 Apr 26;10(5):192. doi: 10.3390/jcdd10050192.
Post-transcatheter aortic valve replacement (TAVR) patient outcome is an important research topic. To accurately assess post-TAVR mortality, we examined a family of new echo parameters (augmented systolic blood pressure (AugSBP) and arterial mean pressure (AugMAP)) derived from blood pressure and aortic valve gradients.
Patients in the Mayo Clinic National Cardiovascular Diseases Registry-TAVR database who underwent TAVR between 1 January 2012 and 30 June 2017 were identified to retrieve baseline clinical, echocardiographic and mortality data. AugSBP, AugMAP and valvulo-arterial impedance (Zva) (Zva) were evaluated using Cox regression. Receiver operating characteristic curve analysis and the c-index were used to assess the model performance against the Society of Thoracic Surgeons (STS) risk score.
The final cohort contained 974 patients with a mean age of 81.4 ± 8.3 years old, and 56.6% were male. The mean STS risk score was 8.2 ± 5.2. The median follow-up duration was 354 days, and the one-year all-cause mortality rate was 14.2%. Both univariate and multivariate Cox regression showed that AugSBP and AugMAP parameters were independent predictors for intermediate-term post-TAVR mortality (all < 0.0001). AugMAP1 < 102.5 mmHg was associated with a 3-fold-increased risk of all-cause mortality 1-year post-TAVR (hazard ratio 3.0, 95%confidence interval 2.0-4.5, < 0.0001). A univariate model of AugMAP1 surpassed the STS score model in predicting intermediate-term post-TAVR mortality (area under the curve: 0.700 vs. 0.587, = 0.005; c-index: 0.681 vs. 0.585, = 0.001).
Augmented mean arterial pressure provides clinicians with a simple but effective approach to quickly identify patients at risk and potentially improve post-TAVR prognosis.
经导管主动脉瓣置换术（TAVR）患者的预后是一个重要的研究课题。为了准确评估TAVR术后死亡率，我们研究了一系列从血压和主动脉瓣梯度得出的新的超声心动图参数（增强收缩压（AugSBP）和动脉平均压（AugMAP））。
在梅奥诊所国家心血管疾病注册-TAVR数据库中，识别出2012年1月1日至2017年6月30日期间接受TAVR的患者，以获取基线临床、超声心动图和死亡率数据。使用Cox回归评估AugSBP、AugMAP和瓣膜-动脉阻抗（Zva）。采用受试者工作特征曲线分析和c指数来评估该模型相对于胸外科医师协会（STS）风险评分的性能。
最终队列包含974例患者，平均年龄为81.4±8.3岁，男性占56.6%。平均STS风险评分为8.2±5.2。中位随访时间为354天，1年全因死亡率为14.2%。单因素和多因素Cox回归均显示，AugSBP和AugMAP参数是TAVR术后中期死亡率的独立预测因素（均P<0.0001）。AugMAP1<102.5 mmHg与TAVR术后1年全因死亡风险增加3倍相关（风险比3.0，95%置信区间2.0-4.5，P<0.0001）。在预测TAVR术后中期死亡率方面，AugMAP1的单因素模型超过了STS评分模型（曲线下面积：0.700对0.587，P=0.005；c指数：0.681对0.585，P=0.001）。
增强平均动脉压为临床医生提供了一种简单但有效的方法，可快速识别有风险的患者，并可能改善TAVR术后的预后。
