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评估经导管主动脉瓣置换术对主动脉瓣狭窄患者心肌做功指数和左心室舒张功能的影响。

Assessing the impact of transcatheter aortic valve replacement on myocardial work indices and left ventricular diastolic function in aortic valve stenosis patients.

机构信息

Montevergine Clinic, Mercogliano, Italy.

Dept. of Advanced Biomedical Science University of Naples "Federico II", Naples, Italy.

出版信息

Echocardiography. 2023 Aug;40(8):768-774. doi: 10.1111/echo.15639. Epub 2023 Jun 21.

Abstract

BACKGROUND

Aortic valve stenosis (AS) is the most common valvular heart disease worldwide. When timely intervention is performed, aortic valve replacement can improve patients' quality and duration of life. Load-independent left ventricular (LV) functional assessments, such as myocardial work indices (MWIs) and LV diastolic function parameters, could help clinicians decide on the optimal timing of intervention.

AIMS

To evaluate the reliability of MWI in AS patients and the changes in MWI and LV diastolic function after transcatheter aortic valve replacement (TAVR).

METHODS

We enrolled 53 consecutive patients with severe AS undergoing TAVR admitted between March 2021 and November 2021. MWIs and LV diastolic function were assessed before and after TAVR for each patient.

RESULTS

All MWIs and LV diastolic function indices improved after TAVR. The degree of MWIs improvement was higher in patients with lower prior-TAVR MWI values, while the more severe the impairment of diastolic function, the greater the post-TAVR benefit.

CONCLUSION

The introduction of myocardial work parameters into the routine assessment of patients with AS could improve our understanding of cardiac performance and aid in identifying the optimal timing for surgical or percutaneous treatment.

摘要

背景

主动脉瓣狭窄(AS)是全球最常见的瓣膜性心脏病。及时进行干预,主动脉瓣置换术可以提高患者的生活质量和延长寿命。负荷独立的左心室(LV)功能评估,如心肌做功指数(MWI)和 LV 舒张功能参数,可以帮助临床医生决定最佳干预时机。

目的

评估 MWI 在 AS 患者中的可靠性,以及经导管主动脉瓣置换术(TAVR)后 MWI 和 LV 舒张功能的变化。

方法

我们纳入了 2021 年 3 月至 2021 年 11 月期间连续 53 例接受 TAVR 的重度 AS 患者。对每位患者在 TAVR 前后评估 MWI 和 LV 舒张功能。

结果

TAVR 后所有 MWI 和 LV 舒张功能指标均改善。MWI 值较低的患者的 MWI 改善程度更高,而舒张功能损害越严重,TAVR 后获益越大。

结论

将心肌做功参数引入 AS 患者的常规评估中,可以提高我们对心脏功能的理解,有助于确定手术或经皮治疗的最佳时机。

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