Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne, UK.
Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne, UK; Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.
Heart Lung Circ. 2023 Dec;32(12):1489-1499. doi: 10.1016/j.hlc.2023.09.024. Epub 2023 Nov 22.
Transvalvular flow rate (TFR) represents a better reflection of transvalvular flow than the stroke volume index (SVi), and has recently emerged as a useful prognostic tool in patients undergoing surgical aortic valve replacement. There is a paucity of data investigating the role of TFR and its relationship with other clinical or echocardiographic factors in patients undergoing transcatheter aortic valve implantation (TAVI).
This was a retrospective single-centre study of 629 consecutive patients who underwent TAVI between March 2009 and September 2020. Pre-TAVI low TFR was defined as <200 c/s. The primary study end point was all-cause mortality.
Low TFR was observed in 41.8% (263/629) of included patients and was associated with increasing age, low body surface area, hypertension, diabetes, atrial fibrillation, left ventricular (LV) dysfunction, and significant mitral regurgitation. LV function status and severity of aortic valve disease were independent predictors of low TFR. Low TFR was significantly associated with long-term all-cause mortality even after adjustment for other risk factors (adjusted hazard ratio [aHR] 1.44; 95% confidence interval [CI] 1.02-2.03; p=0.038). When data were stratified according to SVi, low TFR was an independent predictor of long-term all-cause mortality in patients with normal SVi (aHR 1.98; 95% CI 1.06-3.69; p=0.032) but not in patients with low SVi (HR 1.23; 95% CI 0.71-2.11; p=0.46; p=0.016 for interaction).
Low TFR is common in patients undergoing TAVI and is an independent predictor of all-cause mortality, particularly in patients with normal SVi.
跨瓣流量（TFR）比每搏输出量指数（SVi）更能反映跨瓣流量，最近已成为接受外科主动脉瓣置换术的患者的一种有用的预后工具。在接受经导管主动脉瓣植入术（TAVI）的患者中，关于 TFR 的作用及其与其他临床或超声心动图因素的关系的研究数据很少。
这是一项回顾性单中心研究，纳入了 2009 年 3 月至 2020 年 9 月期间接受 TAVI 的 629 例连续患者。术前 TFR 低定义为<200 c/s。主要研究终点是全因死亡率。
629 例患者中，41.8%（263/629）的患者存在 TFR 低，与年龄增加、低体表面积、高血压、糖尿病、心房颤动、左心室（LV）功能障碍和严重二尖瓣反流有关。LV 功能状态和主动脉瓣疾病的严重程度是 TFR 低的独立预测因素。即使在校正其他危险因素后，TFR 低也与长期全因死亡率显著相关（校正后的危险比 [aHR] 1.44；95%置信区间 [CI] 1.02-2.03；p=0.038）。当根据 SVi 对数据进行分层时，TFR 低是 SVi 正常患者长期全因死亡率的独立预测因素（aHR 1.98；95% CI 1.06-3.69；p=0.032），但在 SVi 低的患者中不是（HR 1.23；95% CI 0.71-2.11；p=0.46；p=0.016 用于交互作用）。
TFR 低在接受 TAVI 的患者中很常见，是全因死亡率的独立预测因素，尤其是在 SVi 正常的患者中。
