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经 TAVR 治疗后远程介电感应值的预后影响。

Prognostic impact of remote dielectric sensing value following TAVR.

机构信息

The Second Department of Internal Medicine, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan.

出版信息

Heart Vessels. 2023 Dec;38(12):1468-1475. doi: 10.1007/s00380-023-02294-1. Epub 2023 Aug 1.

Abstract

Remote dielectric sensing (ReDS) system non-invasively quantifies pulmonary congestion. Re-admission following trans-catheter aortic valve replacement (TAVR) remains an unsolved matter. Residual pulmonary congestion is a strong risk factor of worse clinical outcomes in patients with heart failure. ReDS system may have a prognostic impact in patients undergoing TAVR. Patients who received TAVR and ReDS measurements during index hospitalization between 2021 and 2022 were included. The prognostic impact of ReDS value on the composite endpoint of death or re-admission following index discharge was investigated. Totally, 42 patients (median 84 years, 14 men) were included. Median ReDS value at index discharge was 27% (24%, 30%) and 10 patients had ReDS values > 30%. During a median of 316 (282, 354) days following index discharge, a higher ReDS value at baseline was independently associated with the incidence of composite endpoint with an adjusted hazard ratio of 1.32 (95% confidence interval between 1.10 and 1.58) with a calculated cutoff of 30%, which significantly stratified the cumulative incidence of the composite endpoint (78% in the high ReDS group [N = 10] and 36% in the normal ReDS group [N = 32], p = 0.002). ReDS technology may be a promising tool to predict future clinical outcomes following TAVR by quantifying residual pulmonary congestion. The clinical implication of ReDS-guided aggressive intervention following TAVR remains the next concern.

摘要

远程介电感应(ReDS)系统无创性地量化肺充血。经导管主动脉瓣置换术(TAVR)后的再入院仍然是一个未解决的问题。残余肺充血是心力衰竭患者临床结局恶化的一个强有力的危险因素。ReDS 系统在接受 TAVR 的患者中可能具有预后影响。本研究纳入了 2021 年至 2022 年期间在指数住院期间接受 TAVR 和 ReDS 测量的患者。研究了 ReDS 值对指数出院后死亡或再入院复合终点的预后影响。总共纳入了 42 名患者(中位数 84 岁,14 名男性)。指数出院时的中位数 ReDS 值为 27%(24%,30%),10 名患者的 ReDS 值>30%。在指数出院后中位数为 316(282,354)天的时间里,基线时较高的 ReDS 值与复合终点的发生率独立相关,调整后的风险比为 1.32(95%置信区间为 1.10 至 1.58),计算出的截断值为 30%,这显著分层了复合终点的累积发生率(高 ReDS 组[N=10]为 78%,正常 ReDS 组[N=32]为 36%,p=0.002)。ReDS 技术通过量化残余肺充血,可能成为预测 TAVR 后未来临床结局的有前途的工具。ReDS 指导下的 TAVR 后积极干预的临床意义仍然是下一个关注点。

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