Department of Medicine, Renaissance School of Medicine, State University of New York at Stony Brook, Stony Brook, NY, USA.
Department of Surgery, Renaissance School of Medicine, State University of New York at Stony Brook, Stony Brook, NY, USA.
Cardiovasc Revasc Med. 2024 Aug;65:32-36. doi: 10.1016/j.carrev.2024.03.005. Epub 2024 Mar 7.
Data regarding the impact of reduced left ventricular ejection fraction (LVEF) and/or reduced mean aortic valve gradient (AVG) on outcomes following transcatheter aortic valve intervention (TAVI) have been conflicting. We sought to assess the relationship between LVEF, AVG, and 1-year mortality in patients undergoing TAVI.
We prospectively evaluated 298 consecutive adults undergoing TAVI from 2015 to 2018 at an academic tertiary medical center. Patients were categorized according to LVEF and mean AVG. The primary outcome of interest was all-cause mortality at 1 year.
Of 298 adults undergoing TAVI, 66 (22.1%) had baseline LVEF ≤45% while 232 (77.9%) had baseline LVEF >45%; 173 (58.1%) had baseline AVG < 40mmHg while 125 (41.9%) had baseline AVG ≥ 40mmHg. Rates of 1-year all-cause mortality were significantly higher in patients with LVEF ≤45% (28.8% vs 12.1%, p = 0.001) and those with AVG < 40mmHg (19.7% vs 10.4%, p = 0.031) compared to those with LVEF >45% and AVG ≥ 40mmHg respectively. In multivariable analysis, higher AVG (per mmHg) (OR 0.97, 95% CI 0.94-0.99, p = 0.026) was noted to be independently associated with lower rates of 1-year mortality, while LVEF was not (OR 0.98, 95% CI 0.96-1.01).
In this prospective, contemporary registry of adults undergoing TAVI, while 1-year unadjusted mortality rates are significantly higher in patients with reduced LVEF and reduced AVG, risk-adjusted mortality at 1 year is only higher in those with reduced AVG - not in those with reduced LVEF.
关于左心室射血分数（LVEF）降低和/或平均主动脉瓣梯度（AVG）降低对经导管主动脉瓣介入治疗（TAVI）后结局的影响的数据一直存在争议。我们旨在评估 TAVI 术后 LVEF、AVG 与 1 年死亡率之间的关系。
我们前瞻性评估了 2015 年至 2018 年在一家学术性三级医疗中心接受 TAVI 的 298 例连续成年患者。患者根据 LVEF 和平均 AVG 进行分类。主要研究终点为 1 年全因死亡率。
在 298 例接受 TAVI 的成年患者中，66 例（22.1%）基线 LVEF ≤45%，232 例（77.9%）基线 LVEF>45%；173 例（58.1%）基线 AVG<40mmHg，125 例（41.9%）基线 AVG≥40mmHg。LVEF≤45%的患者（28.8%比 12.1%，p=0.001）和 AVG<40mmHg 的患者（19.7%比 10.4%，p=0.031）1 年全因死亡率明显高于 LVEF>45%和 AVG≥40mmHg 的患者。多变量分析显示，较高的 AVG（每mmHg）（比值比 0.97，95%置信区间 0.94-0.99，p=0.026）与较低的 1 年死亡率独立相关，而 LVEF 则不然（比值比 0.98，95%置信区间 0.96-1.01）。
在这项前瞻性的当代成人 TAVI 登记研究中，尽管 LVEF 和 AVG 降低的患者 1 年未调整死亡率显著升高，但仅在 AVG 降低的患者中，而不是在 LVEF 降低的患者中，风险调整后的 1 年死亡率更高。
