Department of Cardiology, Tachikawa General Hospital, Nagaoka, Japan.
Department of Thoracic Surgery, Tachikawa General Hospital, Nagaoka, Japan.
Heart Vessels. 2024 Feb;39(2):167-174. doi: 10.1007/s00380-023-02321-1. Epub 2023 Oct 16.
To examine reverse atrial electrical remodeling in patients with aortic stenosis (AS) after trans-catheter aortic valve replacement (TAVR). In 65 consecutive patients with severe AS (83 ± 4 years, 47 (72.3%) females), we analyzed ECG records for the P wave duration (PWD) in lead II and P-terminal force (PTFV1) in V1, and measured cardiac dimensions and function by echocardiography (ECHO) following TAVR. Biomarkers were measured to assess myocardial injury by TAVR. TAVR was successfully performed without major complications: the aortic valve area increased from 0.62 ± 0.14 cm to 1.52 ± 0.24cm, and the trans-aortic pressure gradient decreased from 58.4 ± 15.9 mmHg to 15.0 ± 19.6 mmHg. PWD and PTFV increased immediately after TAVR and returned to the pre-TAVR levels on the next day. Then, the PWD declined toward 6 months after TAVR non-significantly in all patients, but significantly in 25 patients with baseline PWD ≥ 130 ms (P = 0.039). PTFV1 showed no long-term change. Improvement was observed in the ejection fraction, all thickness of the left ventricle and in the left atrial dimensions on ECHO. After recovery from transient aggravation by TAVR procedure, PWD reversed slowly, and the change was significant in those with baseline PWD ≥ 130 ms while change in PTFV1 was not significant at 6 months of follow-up. ECHO showed a reversal of remodeling in the left ventricle and in the left atrial dimension after TAVR.
观察经导管主动脉瓣置换术(TAVR)后主动脉瓣狭窄(AS)患者的逆向心房电重构。在 65 例连续的重度 AS 患者(83±4 岁,47 例(72.3%)为女性)中,我们分析了 II 导联 P 波持续时间(PWD)和 V1 导联 P 波终末电势(PTFV1)的心电图记录,并在 TAVR 后通过超声心动图(ECHO)测量心脏尺寸和功能。测量生物标志物以评估 TAVR 引起的心肌损伤。TAVR 成功完成,无重大并发症:主动脉瓣口面积从 0.62±0.14cm 增加到 1.52±0.24cm,跨主动脉压力梯度从 58.4±15.9mmHg 降低到 15.0±19.6mmHg。PWD 和 PTFV1 在 TAVR 后立即增加,并在第二天恢复到 TAVR 前水平。然后,在所有患者中,PWD 在 TAVR 后 6 个月时无显著下降,但在基线 PWD≥130ms 的 25 例患者中显著下降(P=0.039)。PTFV1 无长期变化。ECHO 显示射血分数、左心室所有厚度和左心房尺寸均有改善。在 TAVR 过程中短暂加重后恢复后,PWD 缓慢逆转,在基线 PWD≥130ms 的患者中变化显著,而在 6 个月随访时 PTFV1 变化不显著。ECHO 显示 TAVR 后左心室和左心房重构逆转。