Moya Ana, de Oliveira Elayne Kelen, Delrue Leen, Beles Monika, Buytaert Dimitri, Goethals Marc, Verstreken Sofie, Dierckx Riet, Bartunek Jozef, Heggermont Ward, Wyffels Eric, Vanderheyden Marc
CardioPath PhD Program, Federico II University Hospital, Naples, Italy.
Cardiovascular Center, OLV Hospital, Aalst, Belgium.
Int J Cardiol Heart Vasc. 2024 Jul 24;53:101474. doi: 10.1016/j.ijcha.2024.101474. eCollection 2024 Aug.
Transcatheter aortic valve replacement(TAVR) has shown clear survival benefits in severe aortic valve stenosis(AS). However, patients unable to recover left ventricle function remain at risk with poor long-term survival. This single-center prospective study aims to analyze the supplementary benefits of myocardial work(MW) assessment for baseline risk stratification in patients with severe AS referred for TAVR.
A total of 110 patients with severe AS referred for TAVR were included in the study. Baseline ECG data, transthoracic echocardiographic(TTE) images and blood samples were obtained. The TTE examination was repeated one day and one month after valve replacement. The primary outcome of the study was a composite endpoint consisting of all-cause mortality and HF hospitalization.
During a mean follow-up period of 521 ± 343 days, 29patients(26.4 %) reached the composite endpoint. Baseline troponins, NT-proBNP, sST2, GWI and GCW showed statistically significant differences between groups. Patients with a baseline GWI<2323 mmHg% (sensitivity 0.63 and specificity 0.76)had significantly worse outcome following TAVR. A basic predictive model included QRS-length, TAPSE, LAVI and E/e'. The addition of biomarkers did not yield any further advantages whereas incorporating the GWI cut-off value of 2323 mmHg% significantly enhanced the predictive value. Although there were no significant changes in LVEF and GLS, all patients exhibited a significant reduction in GWI and GCW immediately after TAVR.
Our findings provide evidence for the enhanced usefulness of MW analysis in the initial risk stratification of patients with severe AS referred for TAVR. Specifically, a baseline GWI<2323 mmHg% demonstrates an independent predictor associated with increased incidence of all-cause mortality and HF hospitalization following TAVR.
经导管主动脉瓣置换术（TAVR）已在严重主动脉瓣狭窄（AS）患者中显示出明确的生存获益。然而，无法恢复左心室功能的患者长期生存风险仍然较高。本单中心前瞻性研究旨在分析心肌做功（MW）评估对接受TAVR的严重AS患者基线风险分层的补充益处。
本研究共纳入110例接受TAVR的严重AS患者。获取基线心电图数据、经胸超声心动图（TTE）图像和血样。在瓣膜置换术后1天和1个月重复进行TTE检查。本研究的主要结局是由全因死亡率和心力衰竭住院组成的复合终点。
在平均521±343天的随访期内，29例患者（26.4%）达到复合终点。基线肌钙蛋白、N末端B型利钠肽原（NT-proBNP）、可溶性ST2（sST2）、整体做功指数（GWI）和全球做功指数（GCW）在组间显示出统计学显著差异。基线GWI<2323 mmHg%的患者（敏感性0.63，特异性0.76）TAVR术后结局明显更差。一个基本预测模型包括QRS波时限、三尖瓣环平面收缩期位移（TAPSE）、左房容积指数（LAVI）和E/A'比值。添加生物标志物未产生进一步优势，而纳入2323 mmHg%的GWI临界值显著提高了预测价值。尽管左心室射血分数（LVEF）和左心室纵向应变（GLS）无显著变化，但所有患者在TAVR术后即刻GWI和GCW均显著降低。
我们的研究结果为MW分析在接受TAVR的严重AS患者初始风险分层中的增强实用性提供了证据。具体而言，基线GWI<2323 mmHg%是TAVR术后全因死亡率和心力衰竭住院发生率增加的独立预测因素。
