Università Catto1ica del Sacro Cuore.
Fondazione Policlinico Universitario 'Agostino Gemelli' IRCCS, Department of Cardiovascular Sciences, Rome, Italy.
J Cardiovasc Med (Hagerstown). 2024 Apr 1;25(4):327-333. doi: 10.2459/JCM.0000000000001596. Epub 2024 Feb 12.
Transcatheter aortic valve implantation (TAVI) has become a largely used treatment for severe aortic stenosis. There are limited data, however, about predictors of long-term prognosis in this population. In this study, we assessed whether ventricular arrhythmias may predict clinical outcomes in patients undergoing TAVI.
We performed a 24 h ECG Holter monitoring in 267 patients who underwent TAVI for severe aortic stenosis within 30 days from a successful procedure. The occurrence of frequent premature ventricular complexes (PVCs; ≥30/h), polymorphic PVCs and nonsustained ventricular tachycardia (NSVT) was obtained for each patient. Clinical outcome was obtained for 228 patients (85%), for an average follow-up of 3.5 years (range 1.0-8.6). Cardiovascular events (CVEs; cardiovascular death or resuscitated cardiac arrest) occurred in 26 patients (11.4%) and 63 patients died (27.6%). Frequent PVCs but not polymorphic PVCs and NSVT were found to be associated with CVEs at univariate analysis. Frequent PVCs were indeed found in 12 patients with (46.2%) and 35 without (17.3%) CVEs [hazard ratio 2.30; 95% confidence interval (CI) 1.03-5.09; P = 0.04], whereas polymorphic PVCs were found in 11 (42.3%) and 54 (26.7%) patients of the two groups, respectively (hazard ratio 1.44; 95% CI 0.64-3.25; P = 0.38), and NSVT in 9 (34.6%) and 43 patients of the two groups, respectively (hazard ratio 1.18; 95% CI 0.48-2.87; P = 0.72). Frequent PVCs, however, were not significantly associated with CVEs at multivariate Cox regression analysis (hazard ratio 1.53; 95% CI 0.37-6.30; P = 0.56). Both frequent PVCs, polymorphic PVCs and NSVT showed no significant association with mortality.
In our study, the detection of frequent PVCs at Holter monitoring after TAVI was a predictor of CVEs (cardiovascular death/cardiac arrest), but this association was lost in multivariable analysis.
经导管主动脉瓣植入术（TAVI）已成为治疗严重主动脉瓣狭窄的主要手段。然而，关于该人群的长期预后预测因素的数据有限。在这项研究中，我们评估了室性心律失常是否可以预测 TAVI 术后患者的临床结局。
我们对 267 例在成功手术后 30 天内因严重主动脉瓣狭窄接受 TAVI 的患者进行了 24 小时心电图 Holter 监测。获得了每位患者频发室性期前收缩（PVC；≥30/小时）、多形性 PVC 和非持续室性心动过速（NSVT）的发生情况。对 228 例患者（85%）进行了临床结局评估，平均随访 3.5 年（范围 1.0-8.6）。心血管事件（CVE；心血管死亡或复苏性心脏骤停）发生在 26 例患者（11.4%）和 63 例患者（27.6%）中。单因素分析发现，频发 PVC 但不是多形性 PVC 和 NSVT 与 CVE 相关。频发 PVC 确实发生在 12 例（46.2%）和 35 例（17.3%）CVE 患者中[风险比 2.30；95%置信区间（CI）1.03-5.09；P=0.04]，而多形性 PVC 分别发生在 11 例（42.3%）和 54 例（26.7%）患者中[风险比 1.44；95% CI 0.64-3.25；P=0.38]，NSVT 分别发生在 9 例（34.6%）和 43 例患者中[风险比 1.18；95% CI 0.48-2.87；P=0.72]。然而，频发 PVC 在多变量 Cox 回归分析中与 CVE 无显著相关性（风险比 1.53；95% CI 0.37-6.30；P=0.56）。频发 PVC、多形性 PVC 和 NSVT 均与死亡率无显著相关性。
在我们的研究中，TAVI 后 Holter 监测中频发 PVC 的检出是 CVE（心血管死亡/心脏骤停）的预测因素，但在多变量分析中这种相关性消失了。
