Department of Ultrasound, Second Affiliated Hospital (Xinqiao Hospital), Army Medical University, Chongqing, China.
J Clin Ultrasound. 2023 Nov-Dec;51(9):1453-1460. doi: 10.1002/jcu.23585. Epub 2023 Oct 25.
Mixed aortic valve disease (MAVD) is a frequent concomitant valve disease with unique cardiac pathological changes compared to predominant aortic stenosis (PAS). The previous studies about the MAVD are contradictory. Therefore, a new perspective is needed to assess the value of TAVR for this cohort of patients.
From January 2018 to December 2021, 90 MAVD patients and 72 PAS patients who underwent TAVR in our hospital were collected. 1:1 propensity score matching analysis was used to control the bias in patient selection. The dynamic changes in left ventricular morphology and hemodynamics were compared by generalized estimating equations. Univariate or multivariate logistic regression analysis was used to screen for independent risk factors for the non-occurrence of left ventricular reverse remodeling (non-LVRR).
After the matching procedure, 112 patients were included in the analysis (56 in each group). Baseline characteristics were similar between the two groups. LVRR occurred in both groups, but MAVD had greater left ventricular end-diastolic volume index and left ventricular mass index, a higher incidence of mitral regurgitation (MR), and a more pronounced transformation of ventricular geometry patterns. Post-operative MR (odd ratio [OR]: 10.05; 95% confidence interval [CI]: 2.08-48.57; p < .001) and coronary artery disease (OR: 2.82; 95% CI: 1.08-7.34; p = .034) were independent risk factors for non-LVRR.
LVRR also occurs in patients with MAVD, post-operative MR and coronary artery disease were independent risk factors for non-LVRR.
与主要主动脉瓣狭窄（PAS）相比，混合性主动脉瓣疾病（MAVD）是一种常见的伴发瓣膜疾病，具有独特的心脏病理变化。以前关于 MAVD 的研究结果相互矛盾。因此，需要新的视角来评估 TAVR 对这一组患者的价值。
收集 2018 年 1 月至 2021 年 12 月在我院接受 TAVR 的 90 例 MAVD 患者和 72 例 PAS 患者。采用 1:1 倾向评分匹配分析来控制患者选择中的偏倚。采用广义估计方程比较左心室形态和血液动力学的动态变化。采用单变量或多变量逻辑回归分析筛选左心室逆向重构（non-LVRR）不发生的独立危险因素。
匹配后，共有 112 例患者纳入分析（每组 56 例）。两组患者的基线特征相似。两组均发生 LVRR，但 MAVD 患者的左心室舒张末期容积指数和左心室质量指数更高，二尖瓣反流（MR）发生率更高，心室几何形态变化更为明显。术后 MR（比值比 [OR]：10.05；95%置信区间 [CI]：2.08-48.57；p<0.001）和冠心病（OR：2.82；95%CI：1.08-7.34；p=0.034）是 non-LVRR 的独立危险因素。
MAVD 患者也会发生 LVRR，术后 MR 和冠心病是 non-LVRR 的独立危险因素。
