Department of Internal Medicine I, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany.
Comprehensive Heart Failure Center, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany.
Clin Res Cardiol. 2024 Mar;113(3):481-495. doi: 10.1007/s00392-023-02350-w. Epub 2024 Jan 22.
Transcatheter aortic valve implantation (TAVI) has emerged as the treatment of choice for many patients with severe symptomatic aortic stenosis. We sought to identify the echocardiographic predictors of 30-day and 1-year outcomes after TAVI in patients with preserved or reduced left ventricular ejection fraction (LVEF).
This single-centre study included 618 aortic stenosis patients (mean age 82 ± 6 years, 47.1% male; 74.8% LVEF > 50%) who underwent balloon-expandable TAVI between July 2009 and October 2018 in our hospital. All patients completed at least 6 months of follow-up by medical history review or telephone interview (median 24, quartiles 12-42 months). The primary endpoint was all-cause death.
All-cause mortality rate was 5.2% (LVEF > 50%: 4.3% vs. LVEF ≤ 50%: 7.7%, p = 0.141) at 30 days and 15.4% (LVEF > 50%: 14.7% vs. LVEF ≤ 50%: 17.3%, p = 0.443) at 12 months post TAVI. Overall all-cause mortality rate was 45.1% (LVEF > 50%: 44.6% vs. LVEF ≤ 50%: 46.8%, p = 0.643). Mean survival time post TAVI was 51 months [95% CI (48; 55)]. In TAVI patients with LVEF > 50%, multivariate Cox regression analysis revealed several independent predictors for increased risk of death after adjusting for echocardiographic and clinical covariates: TAPSE (≤ 17 vs. > 17 mm, HR 1.528, p = 0.016) and sPAP (> 30 vs. ≤ 30 mmHg, HR 1.900, p = 0.002) for overall mortality, E/E' septal for 30-day mortality (> 21 vs. ≤ 21, HR 14.462, p = 0.010) and 12-month mortality (> 21 vs. ≤ 21, HR 1.881, p = 0.026). In TAVI patients with LVEF ≤ 50%, no independent echocardiographic predictors for outcome could be identified.
LVEF is not a predictor of short- and long-term mortality after TAVI. In patients with preserved LVEF, left ventricular filling pressure (E/E´), systolic pulmonary artery pressure (sPAP), and TAPSE are echocardiographic risk factors for increased mortality post TAVI.
经导管主动脉瓣置换术（TAVI）已成为许多严重症状性主动脉瓣狭窄患者的首选治疗方法。我们试图确定射血分数保留或降低的患者 TAVI 后 30 天和 1 年结局的超声心动图预测因素。
这项单中心研究纳入了 618 例主动脉瓣狭窄患者（平均年龄 82±6 岁，47.1%为男性；74.8%射血分数＞50%），他们于 2009 年 7 月至 2018 年 10 月在我院接受球囊扩张 TAVI。所有患者均通过病史回顾或电话访谈完成至少 6 个月的随访（中位数 24 个月，四分位间距 12-42 个月）。主要终点为全因死亡。
30 天和 12 个月时全因死亡率分别为 5.2%（射血分数＞50%：4.3% vs. 射血分数≤50%：7.7%，p=0.141）和 15.4%（射血分数＞50%：14.7% vs. 射血分数≤50%：17.3%，p=0.443）。TAVI 后总体全因死亡率为 45.1%（射血分数＞50%：44.6% vs. 射血分数≤50%：46.8%，p=0.643）。TAVI 后平均生存时间为 51 个月[95%置信区间（48；55）]。在射血分数＞50%的 TAVI 患者中，多变量 Cox 回归分析显示，在调整超声心动图和临床协变量后，几个独立的预测因素可增加死亡风险：TAPSE（≤17 vs. ＞17mm，HR 1.528，p=0.016）和 sPAP（＞30 vs. ≤30mmHg，HR 1.900，p=0.002）与全因死亡率相关，E/E'间隔与 30 天死亡率（＞21 vs. ≤21，HR 14.462，p=0.010）和 12 个月死亡率（＞21 vs. ≤21，HR 1.881，p=0.026）相关。在射血分数≤50%的 TAVI 患者中，未发现独立的超声心动图预测因素。
射血分数不是 TAVI 后短期和长期死亡率的预测因素。在射血分数保留的患者中，左心室充盈压（E/E'）、肺动脉收缩压（sPAP）和 TAPSE 是 TAVI 后增加死亡率的超声心动图危险因素。
