Winkler Neria E, Anwer Shehab, Reeve Kelly A, Michel Jonathan M, Kasel Albert M, Tanner Felix C
Department of Cardiology, University Heart Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
Department of Biostatistics, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.
Front Cardiovasc Med. 2023 Sep 7;10:1252872. doi: 10.3389/fcvm.2023.1252872. eCollection 2023.
This study aims at exploring biventricular remodelling and its implications for outcome in a representative patient cohort with severe aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI).
Pre-interventional echocardiographic examinations of 100 patients with severe AS undergoing TAVI were assessed by speckle tracking echocardiography of both ventricles. Association with mortality was determined for right ventricular global longitudinal strain (RVGLS), RV free wall strain (RVFWS) and left ventricular global longitudinal strain (LVGLS). During a median follow-up of 1,367 [959-2,123] days, 33 patients (33%) died. RVGLS was lower in non-survivors [-13.9% (-16.4 to -12.9)] than survivors [-17.1% (-20.2 to -15.2); = 0.001]. In contrast, LVGLS as well as the conventional parameters LV ejection fraction (LVEF) and RV fractional area change (RVFAC) did not differ ( = ns). Kaplan-Meier analyses indicated a reduced survival probability when RVGLS was below the -14.6% cutpoint ( < 0.001). Lower RVGLS was associated with higher mortality [HR 1.13 (95% CI 1.04-1.23); = 0.003] independent of LVGLS, LVEF, RVFAC, and EuroSCORE II. Addition of RVGLS clearly improved the fitness of bivariable and multivariable models including LVGLS, LVEF, RVFAC, and EuroSCORE II with potential incremental value for mortality prediction. In contrast, LVGLS, LVEF, and RVFAC were not associated with mortality.
In patients with severe AS undergoing TAVI, RVGLS but not LVGLS was reduced in non-survivors compared to survivors, differentiated non-survivors from survivors, was independently associated with mortality, and exhibited potential incremental value for outcome prediction. RVGLS appears to be more suitable than LVGLS for risk stratification in AS and timely valve replacement.
本研究旨在探讨在接受经导管主动脉瓣植入术（TAVI）的重度主动脉瓣狭窄（AS）代表性患者队列中双心室重构及其对预后的影响。
对100例接受TAVI的重度AS患者进行介入前超声心动图检查，采用双心室斑点追踪超声心动图进行评估。确定右心室整体纵向应变（RVGLS）、右心室游离壁应变（RVFWS）和左心室整体纵向应变（LVGLS）与死亡率的相关性。在中位随访1367[959 - 2123]天期间，33例患者（33%）死亡。非幸存者的RVGLS[-13.9%（-16.4至-12.9）]低于幸存者[-17.1%（-20.2至-15.2）；P = 0.001]。相比之下，LVGLS以及传统参数左心室射血分数（LVEF）和右心室面积变化分数（RVFAC）没有差异（P = 无显著性差异）。Kaplan-Meier分析表明，当RVGLS低于-14.6%切点时，生存概率降低（P < 0.001）。较低的RVGLS与较高的死亡率相关[风险比1.13（95%置信区间1.04 - 1.23）；P = 0.003]，独立于LVGLS、LVEF、RVFAC和欧洲心脏手术风险评估系统II（EuroSCORE II）。加入RVGLS明显改善了包括LVGLS、LVEF、RVFAC和EuroSCORE II的双变量和多变量模型的拟合度，对死亡率预测具有潜在的增量价值。相比之下，LVGLS、LVEF和RVFAC与死亡率无关。
在接受TAVI的重度AS患者中，与幸存者相比，非幸存者的RVGLS降低，但LVGLS未降低，可区分非幸存者和幸存者，与死亡率独立相关，并对预后预测具有潜在的增量价值。对于AS患者的风险分层和及时瓣膜置换，RVGLS似乎比LVGLS更合适。
