CA125 指导下的 TAVI 术前医学优化：对生活质量和临床结局的影响。
Carbohydrate antigen 125-guided pre-TAVI medical optimization: impact on quality of life and clinical outcomes.
机构信息
Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Valencia, Spain; Instituto de Investigación Sanitaria (INCLIVA), Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
Servicio de Cardiología, Hospital General de Castellón, Castellón, Spain.
出版信息
Rev Esp Cardiol (Engl Ed). 2024 Sep;77(9):750-758. doi: 10.1016/j.rec.2024.01.002. Epub 2024 Feb 2.
INTRODUCTION AND OBJECTIVES
Carbohydrate antigen 125 (CA125), a biomarker associated with fluid overload, has proven useful in managing diuretic therapy in heart failure. We aimed to evaluate the impact of diuretic optimization guided by CA125 before transcatheter aortic valve implantation (TAVI) on outcomes.
METHODS
This prospective interventional study enrolled patients scheduled for TAVI, in whom baseline CA125 was measured 2 weeks before TAVI. Patients with CA125 ≥ 20 U/mL underwent diuretic up-titration before TAVI. Three groups were included: group I) baseline CA125 <20 U/mL; IIa) CA125 ≥ 20 U/mL that decreased after treatment, and IIb) CA125 ≥ 20 U/mL that did not decrease. The primary outcome was changes in the Kansas City Cardiomyopathy Questionnaire at 3 and 12 months. The secondary endpoint was clinical events.
RESULTS
The study included 184 patients (115 group I, 46 IIa, and 23 IIb). Groups I and IIa exhibited early and sustained improvements in the Kansas City Cardiomyopathy Questionnaire (group I: 18.9 points [95%CI, 15.7-22.1; P <.001] at 90 days, and 18.1 [95%CI, 14.9-21.4, P <.001] at 1 year; group IIa: 21.1 points [95%CI, 15.4-26.7; P <.001] and 19.5 [95%CI, 13.9-25.1; P <.001] respectively). In contrast, in group IIb there was no significant improvement at 90 days (P=.12), with improvement being significant only at 1 year (17.8 points, 95%CI, 5.9-29.6; P=.003). Over a median follow-up of 20.7 months, there were 63 (27.83%) deaths or heart failure admissions. Multivariate analysis showed a lower risk of events in group I vs IIb (HR, 0.28; 95%CI, 0.14-0.58; P <.001), and IIa vs IIb (HR, 0.24; 95%CI, 0.11-0.55; P <.001).
CONCLUSIONS
Patients with persistently high CA125 despite diuretic therapy pre-TAVI showed slower functional recovery and poorer clinical outcomes after TAVI.
简介和目的
与液体过载相关的生物标志物糖链抗原 125（CA125）在心力衰竭的利尿剂治疗管理中已被证明具有一定的效果。我们旨在评估经导管主动脉瓣置换术（TAVI）前 CA125 指导的利尿剂优化对结局的影响。
方法
这项前瞻性干预研究纳入了计划接受 TAVI 的患者，在 TAVI 前 2 周测量了基线 CA125。CA125≥20U/mL 的患者在 TAVI 前接受利尿剂滴定。包括三组：I 组：基线 CA125<20U/mL；IIa 组：CA125≥20U/mL 但治疗后下降；IIb 组：CA125≥20U/mL 且治疗后未下降。主要结局是 3 个月和 12 个月时堪萨斯城心肌病问卷的变化。次要终点是临床事件。
结果
研究纳入了 184 例患者（I 组 115 例，IIa 组 46 例，IIb 组 23 例）。I 组和 IIa 组在堪萨斯城心肌病问卷方面均表现出早期和持续的改善（I 组：90 天改善 18.9 分[95%CI，15.7-22.1；P<.001]，1 年改善 18.1 分[95%CI，14.9-21.4，P<.001]；IIa 组：90 天改善 21.1 分[95%CI，15.4-26.7；P<.001]，1 年改善 19.5 分[95%CI，13.9-25.1；P<.001]）。相比之下，IIb 组在 90 天内无明显改善（P=.12），仅在 1 年时改善有统计学意义（17.8 分，95%CI，5.9-29.6；P=.003）。在中位随访 20.7 个月期间，有 63 例（27.83%）死亡或心力衰竭入院。多变量分析显示，I 组与 IIb 组（HR，0.28；95%CI，0.14-0.58；P<.001），IIa 组与 IIb 组（HR，0.24；95%CI，0.11-0.55；P<.001）的事件风险较低。
结论
尽管 TAVI 前进行了利尿剂治疗，但 CA125 持续升高的患者在 TAVI 后功能恢复较慢，临床结局较差。
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