Mao Yu, Liu Yang, Zhai Mengen, Jin Ping, Zhang Haibo, Wei Lai, Shang Xiaoke, Guo Yingqiang, Pan Xiangbin, Yang Jian
Department of Cardiovascular Surgery, Xijing Hospital, Xi'an, Shaanxi, China.
Department of Cardiovascular Surgery, Anzhen Hospital, Capital Medical University, Beijing, China.
Front Cardiovasc Med. 2024 Aug 30;11:1424116. doi: 10.3389/fcvm.2024.1424116. eCollection 2024.
Aortic regurgitation (AR) may lead to right ventricular dysfunction (RVD), but the prognostic value of RVD in patients undergoing transcatheter aortic valve replacement (TAVR) remains unclear. Our goal was to evaluate the clinical implications, predictors and prognostic significance of RVD in patients with pure AR after TAVR.
In this multicentre prospective study, patients undergoing TAVR were included between January 2019 and April 2021. The patients were divided into four groups according to the results of transthoracic echocardiography pre- and post-TAVR. The primary end point was 2-year all-cause mortality.
A total of 648 patients were divided into four groups: 325 patients (54.3%) in the no RVD group; 106 patients (17.7%) in the new-onset RVD group; 73 patients (12.2%) in the normalized RVD group; and 94 patients (15.7%) in the residual RVD group. At the 2-year follow-up, there were significant differences in all-cause mortality among the four groups (5.2%, 12.3%, 11.0% and 17.0%, respectively; < 0.05). New-onset RVD was correlated with an increased risk of all-cause death and a composite end point and normalized RVD improved clinical outcomes of baseline RVD. Predictors of new-onset RVD included a higher Society of Thoracic Surgeons score, larger left ventricular end-diastolic volume, lower left ventricular ejection fraction, higher systolic pulmonary artery pressure and smaller RV base diameter.
Changes in periprocedural RVD status significantly affect the risk stratification outcomes after TAVR. Therefore, they may be used as part of decision-making and risk assessment strategies.
ClinicalTrials.gov Protocol Registration System (NCT02917980).
主动脉瓣反流（AR）可能导致右心室功能障碍（RVD），但RVD在接受经导管主动脉瓣置换术（TAVR）患者中的预后价值仍不明确。我们的目标是评估TAVR术后单纯AR患者中RVD的临床意义、预测因素及预后意义。
在这项多中心前瞻性研究中，纳入了2019年1月至2021年4月期间接受TAVR的患者。根据TAVR术前和术后经胸超声心动图结果将患者分为四组。主要终点为2年全因死亡率。
共648例患者分为四组：无RVD组325例（54.3%）；新发RVD组106例（17.7%）；RVD恢复正常组73例（12.2%）；残余RVD组94例（15.7%）。在2年随访时，四组全因死亡率存在显著差异（分别为5.2%、12.3%、11.0%和17.0%；P<0.05）。新发RVD与全因死亡风险增加及复合终点相关，而RVD恢复正常改善了基线RVD患者的临床结局。新发RVD的预测因素包括较高的胸外科医师协会评分、较大的左心室舒张末期容积、较低的左心室射血分数、较高的收缩期肺动脉压和较小的右心室基底直径。
围手术期RVD状态的变化显著影响TAVR术后的风险分层结果。因此，它们可作为决策和风险评估策略的一部分。
ClinicalTrials.gov协议注册系统（NCT02917980）。
