Jonnala Vinesh R, Quadri Haroon S, Pourafkari Leili, Fernandez Stanley F, Iyer Vijay S, Nader Nader D
Department of Medicine at Rutgers, Newark, NJ, USA.
Department of Anesthesiology, University at Buffalo, Buffalo, NY, USA.
Cardiovasc Revasc Med. 2025 Mar;72:38-43. doi: 10.1016/j.carrev.2024.06.014. Epub 2024 Jun 17.
Left ventricular systolic dysfunction in patients with severe aortic stenosis (AS) may result in low transvalvular gradients and underestimation of AS severity. A low-flow state may occur with reduced LVEF. Little is known about the implications of low compared to normal flow in patients with reduced LVEF undergoing transcatheter aortic valve replacement (TAVR).
We compared survival rates with degree of flow across stenosed aortic valves and left ventricular dysfunction. We hypothesized that the stroke volume index (SVI) offers essential information regarding survival following TAVR.
We retrospectively reviewed patients with LVEF <50 % undergoing TAVR at the Gates Vascular Institute in Buffalo, New York, from 2012 to 2017. We performed Receiver Operator Characteristics to examine the value of SVI in predicting the postoperative outcome of patients. Kaplan-Meier and Cox regression analyses were used to investigate the effect of a low-flow state on five-year survival in patients with systolic dysfunction undergoing TAVR.
Five-year survival following TAVR was decreased in patients with low-flow AS (SVI <35 mL/m) compared to patients with normal flow. Seventy-four percent (n = 50) of patients with low-flow compared to 43 % (n = 22) of patients with normal flow were deceased five years post-TAVR (p ≤0.001). ROC curve indicated SVI to be a clinical predictor of five year survival (AUC 0.732, 95 % CI: 0.641-0.823, p < 0.001).
Patients with systolic dysfunction and low transvalvular flow AS had increased mortality five years following TAVR. These findings highlight a better prognosis in patients with normal flow and LV systolic dysfunction.
Low-flow aortic stenosis can occur with reduced left ventricular function. We compared survival rates of patients with known reduced left ventricular function in low-flow and normal flow aortic stenosis. This retrospective single-center study examined mortality rates following transcatheter aortic valve replacement. The mean gradient was not a predictor of mortality. This study shows patients with low-flow aortic stenosis have decreased five-year survival following valve replacement.
重度主动脉瓣狭窄（AS）患者的左心室收缩功能障碍可能导致跨瓣压差降低，从而低估AS的严重程度。左心室射血分数（LVEF）降低时可能会出现低流量状态。对于接受经导管主动脉瓣置换术（TAVR）的LVEF降低患者，与正常流量相比，低流量的影响知之甚少。
我们比较了存活概率与通过狭窄主动脉瓣的流量程度以及左心室功能障碍之间的关系。我们假设每搏量指数（SVI）为TAVR后的存活情况提供了重要信息。
我们回顾性分析了2012年至2017年在纽约州布法罗市盖茨血管研究所接受TAVR的LVEF<50%的患者。我们进行了受试者工作特征分析，以检验SVI在预测患者术后结局中的价值。采用Kaplan-Meier和Cox回归分析来研究低流量状态对接受TAVR的收缩功能障碍患者五年生存率的影响。
与正常流量患者相比，低流量AS（SVI<35 mL/m²）患者TAVR后的五年生存率降低。TAVR术后五年，低流量患者中有74%（n = 50）死亡，而正常流量患者中这一比例为43%（n = 22）（p≤0.001）。ROC曲线表明SVI是五年生存率的临床预测指标（AUC 0.732，95%CI：0.641-0.823，p<0.001）。
收缩功能障碍且跨瓣流量低的AS患者在TAVR术后五年死亡率增加。这些发现凸显了正常流量且左心室收缩功能障碍患者的预后更好。
左心室功能降低时可出现低流量主动脉瓣狭窄。我们比较了已知左心室功能降低的低流量和正常流量主动脉瓣狭窄患者的存活率。这项回顾性单中心研究检查了经导管主动脉瓣置换术后的死亡率。平均压差不是死亡率的预测指标。本研究表明低流量主动脉瓣狭窄患者瓣膜置换术后五年生存率降低。
