经导管主动脉瓣置换术后的舒张功能障碍与健康状况结局

Diastolic Dysfunction and Health Status Outcomes After Transcatheter Aortic Valve Replacement.

作者信息

El-Zein Rayan S, Malik Ali O, Cohen David J, Spertus John A, Saxon John T, Pibarot Philippe, Hahn Rebecca T, Alu Maria C, Shang Kan, Kodali Susheel K, Thourani Vinod H, Leon Martin B, Mack Michael J, Chhatriwalla Adnan K

机构信息

Division of Cardiology, University of Missouri-Kansas City, Missouri, USA.

Division of Cardiology, Saint Luke's Mid America Heart Institute, Missouri, USA.

出版信息

Struct Heart. 2023 Sep 27;8(1):100225. doi: 10.1016/j.shj.2023.100225. eCollection 2024 Jan.

DOI:10.1016/j.shj.2023.100225

PMID:38283566

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10818150/

Abstract

BACKGROUND

Baseline left ventricular diastolic dysfunction (LVDD) is associated with poor health status in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement (TAVR), but health status improvement after TAVR appears similar across all grades of LVDD. Here, we aim to examine the relationship between changes in LVDD severity and health status outcomes following TAVR.

METHODS

Patients who underwent TAVR and had evaluable LVDD at both baseline and 1 year in the PARTNER (Placement of Aortic Transcatheter Valves) 2 SAPIEN 3 registries and PARTNER 3 trial were analyzed. LVDD grade was evaluated using echocardiography core lab data and an adapted definition of American Society of Echocardiography guidelines. Health status was assessed using the Kansas City Cardiomyopathy Questionnaire Overall Summary (KCCQ-OS) score. The association between ΔLVDD severity and ΔKCCQ-OS was examined using linear regression models adjusted for baseline KCCQ-OS.

RESULTS

Of 1100 patients, 724 (65.8%), 283 (25.7%), and 93 (8.5%) had grade 0/1, 2, and 3 LVDD at baseline, respectively. At 1 year, LVDD severity was unchanged in 790 (71.8%) patients, improved in 189 (17.2%), and worsened in 121 (11.0%). Among 376 patients with baseline grade 2 or 3 LVDD, 50.3% had improvement in LVDD. In the overall cohort, KCCQ-OS score improved by 21.9 points at 1 year. There was a statistically significant association between change in LVDD severity (improved, unchanged, and worsened) and ΔKCCQ-OS at 1 year ( = 0.007).

CONCLUSIONS

Change in LVDD grade was associated with change in health status 1 year following TAVR.

摘要

背景

基线左心室舒张功能障碍（LVDD）与接受经导管主动脉瓣置换术（TAVR）的严重主动脉瓣狭窄患者的健康状况不佳相关，但TAVR术后所有LVDD分级患者的健康状况改善情况似乎相似。在此，我们旨在研究TAVR术后LVDD严重程度变化与健康状况结果之间的关系。

方法

分析了在PARTNER（主动脉经导管瓣膜置入）2 SAPIEN 3注册研究和PARTNER 3试验中接受TAVR且在基线和1年时具有可评估LVDD的患者。使用超声心动图核心实验室数据和美国超声心动图学会指南的适应性定义评估LVDD分级。使用堪萨斯城心肌病问卷总体总结（KCCQ-OS）评分评估健康状况。使用针对基线KCCQ-OS进行调整的线性回归模型检查ΔLVDD严重程度与ΔKCCQ-OS之间的关联。

结果

在1100例患者中，分别有724例（65.8%）、283例（25.7%）和93例（8.5%）在基线时为0/1级、2级和3级LVDD。1年时，790例（71.8%）患者的LVDD严重程度未改变，189例（17.2%）患者有所改善，121例（11.0%）患者恶化。在376例基线为2级或3级LVDD的患者中，50.3%的患者LVDD有所改善。在整个队列中，KCCQ-OS评分在1年时提高了21.9分。LVDD严重程度的变化（改善、未改变和恶化）与1年时的ΔKCCQ-OS之间存在统计学上的显著关联（P = 0.007）。