Kemi Yuta, Yamashita Eiji, Kario Kazuomi, Kinoshita Satoshi, Sugano Kouta, Yano Hideki, Kuribara Jun, Kawaguchi Ren, Naito Shigeto
Division of Cardiology, Gunma Prefectural Cardiovascular Center Maebashi Japan.
Division of Cardiology, Jichi Medical University School of Medicine Shimotsuke Japan.
Circ Rep. 2024 May 22;6(6):223-229. doi: 10.1253/circrep.CR-24-0020. eCollection 2024 Jun 10.
The prognostic significance of different presentations of aortic stenosis (AS) remains unclear. Our aim was to analyze outcomes after transcatheter aortic valve replacement (TAVR) according to preoperative AS symptoms. We retrospectively enrolled 369 consecutive patients (age 84.3±5.0 years, and 64% females) who underwent TAVR from 2014 to 2021. We divided them into 4 groups by the main preoperative symptom: asymptomatic (n=50), chest pain (n=46), heart failure (HF; n=240), and syncope (n=33). Post-TAVR rates of HF readmission, all-cause death and cardiac death were compared among the 4 groups. The 4 groups showed no significant trends in age, sex, stroke volume index, or echocardiography indices of AS severity. During a follow-up, the overall survival rate at 1 and 5 years after TAVR was 97% and 90% in the asymptomatic group, 96% and 69% in the chest pain group, 93% and 69% in the HF group, and 90% and 72% in the syncope group, respectively. HF and syncope symptom had significantly lower HF readmission or cardiac death-free survival at 5 years after TAVR (log-rank test P=0.038). In the Cox hazard multivariate analysis, preoperative syncope was an independent predictor of future HF readmission or cardiac death after TAVR (HR=9.87; 95% CI 1.67-97.2; P=0.035). AS patients with preoperative syncope or HF had worse outcomes after TAVR than those with angina or no symptoms.
主动脉瓣狭窄（AS）不同表现形式的预后意义仍不明确。我们的目的是根据术前AS症状分析经导管主动脉瓣置换术（TAVR）后的结局。我们回顾性纳入了2014年至2021年连续接受TAVR的369例患者（年龄84.3±5.0岁，女性占64%）。我们根据术前主要症状将他们分为4组：无症状（n=50）、胸痛（n=46）、心力衰竭（HF；n=240）和晕厥（n=33）。比较了4组患者TAVR后HF再入院率、全因死亡率和心源性死亡率。4组在年龄、性别、每搏输出量指数或AS严重程度的超声心动图指标方面无显著趋势。随访期间，无症状组TAVR后1年和5年的总生存率分别为97%和90%，胸痛组为96%和69%，HF组为93%和69%，晕厥组为90%和72%。HF和晕厥症状组在TAVR后5年的HF再入院或无心脏死亡生存率显著更低（对数秩检验P=0.038）。在Cox风险多因素分析中，术前晕厥是TAVR后未来HF再入院或心源性死亡的独立预测因素（HR=9.87；95%CI 1.67-97.2；P=0.035）。术前有晕厥或HF的AS患者TAVR后的结局比有胸痛或无症状的患者更差。
