Morita Yuichi, Ikenaga Hiroki, Takeda Atsushi, Nakano Takayuki, Higashihara Tasuku, Watanabe Noriaki, Sada Yoshiharu, Utsunomiya Hiroto, Takahashi Shinya, Fukuda Yukihiro, Nakano Yukiko
Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Japan.
Department of Cardiovascular Medicine, Hiroshima City Hiroshima Citizens Hospital, Japan.
Intern Med. 2025 Apr 15;64(8):1171-1179. doi: 10.2169/internalmedicine.4205-24. Epub 2024 Sep 27.
Objective The mean platelet volume (MPV), a marker of platelet activity, is significantly higher in patients with aortic stenosis (AS) than in those without AS. The association between the platelet function and prosthesis-patient mismatch (PPM) after transcatheter aortic valve replacement (TAVR) remains unknown. Therefore, we investigated this association by measuring the MPV. Methods Of 237 patients who underwent TAVR, 148 with a median age of 84 years old were enrolled in this study. Blood tests and transthoracic echocardiography were performed at baseline and approximately six months after TAVR. PPM was defined as an aortic valve area index ≤0.85 cm/m after TAVR. Variable changes from baseline to six-month follow-up were compared between patients with and without PPM. Results Forty-five patients (30%) developed PPM. The MPV was significantly higher in patients with PPM than in those without PPM. However, regarding the magnitude of change, the MPV was significantly less reduced in patients with PPM, and the percentage of patients with reduced MPV was lower in patients with PPM than in those without PPM. A logistic regression analysis revealed that a higher MPV and lack of MPV reduction at the six-month follow-up were independent predictors of PPM. Conclusion MPV values at the six-month follow-up were associated with PPM after TAVR in patients with AS. MPV values increase when PPM is present after TAVR and may be an indicator during the postoperative follow-up.
目的 平均血小板体积（MPV）是血小板活性的一个指标，在主动脉瓣狭窄（AS）患者中显著高于无AS的患者。经导管主动脉瓣置换术（TAVR）后血小板功能与人工瓣膜-患者不匹配（PPM）之间的关联尚不清楚。因此，我们通过测量MPV来研究这种关联。方法 在237例行TAVR的患者中，148例（中位年龄84岁）纳入本研究。在基线时和TAVR后约6个月进行血液检查和经胸超声心动图检查。PPM定义为TAVR后主动脉瓣面积指数≤0.85 cm/m²。比较有和无PPM患者从基线到6个月随访的变量变化。结果 45例患者（30%）发生PPM。有PPM的患者MPV显著高于无PPM的患者。然而，就变化幅度而言，有PPM的患者MPV降低幅度显著较小，且有PPM的患者中MPV降低的患者百分比低于无PPM的患者。逻辑回归分析显示，较高的MPV以及6个月随访时MPV未降低是PPM的独立预测因素。结论 AS患者TAVR后6个月随访时的MPV值与PPM相关。TAVR后出现PPM时MPV值升高，可能是术后随访的一个指标。
