Fukutomi Motoki, Onishi Takayuki, Ando Tomo, Higuchi Ryosuke, Hagiya Kenichi, Saji Mike, Takamisawa Itaru, Iguchi Nobuo, Takayama Morimasa, Shimizu Atsushi, Shimizu Jun, Doi Shinichiro, Okazaki Shinya, Sato Kei, Tamura Harutoshi, Yokoyama Hiroaki, Takanashi Shuichiro, Tobaru Tetsuya
Department of Cardiology, Kawasaki Saiwai Hospital, Kawasaki, Japan.
Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan.
Catheter Cardiovasc Interv. 2024 Dec;104(7):1469-1476. doi: 10.1002/ccd.31261. Epub 2024 Oct 14.
A history of hospitalization for heart failure (HHF) before transcatheter aortic valve implantation (TAVI) or surgical aortic valve replacement is associated with the prognosis of patients with severe aortic stenosis (AS). However, the impact of prior HHF on clinical outcomes after contemporary TAVI using new-generation transcatheter heart valves (THVs) has not been thoroughly investigated.
Using data from the aLliAnce for exPloring cLinical prospects of AortiC valvE disease (LAPLACE)-TAVI registry, we investigated 2,752 patients who underwent TAVI with new-generation THVs with a median follow-up of 627 days. The primary outcomes were all-cause mortality and heart failure readmission after TAVI.
Patients with a history of HHF (n = 809) showed a higher 30-day mortality than patients without prior HHF (n = 1,943). A Kaplan-Meier analysis revealed that the prior HHF group showed a higher incidence of the primary outcome than the non-prior HHF group (27.4% vs. 16.4%, log-rank p = 0.001). In a Cox regression analysis, prior HHF was significantly associated with the risk of the primary outcome, even after adjusting for covariates (hazard ratio, 1.344; 95% confidence interval, 1.103-1.638; p = 0.003). A subanalysis showed that the prior HHF group with ejection fraction (EF) ≥ 50% had a higher risk of the primary outcome than the non-prior HHF group, whereas the prior HHF group with EF < 50% had the worst outcome.
A history of prior HHF is associated with worse outcomes in patients with severe AS, both in those with preserved EF and those with reduced EF, even after TAVI using new-generation devices.
在经导管主动脉瓣植入术（TAVI）或外科主动脉瓣置换术之前有心力衰竭住院史（HHF）与严重主动脉瓣狭窄（AS）患者的预后相关。然而，既往HHF对使用新一代经导管心脏瓣膜（THV）的当代TAVI术后临床结局的影响尚未得到充分研究。
利用探索主动脉瓣疾病临床前景联盟（LAPLACE）-TAVI注册研究的数据，我们调查了2752例行新一代THV TAVI术的患者，中位随访时间为627天。主要结局为TAVI术后全因死亡率和心力衰竭再入院率。
有HHF病史的患者（n = 809）30天死亡率高于无既往HHF的患者（n = 1943）。Kaplan-Meier分析显示，既往HHF组主要结局的发生率高于非既往HHF组（27.4%对16.4%，对数秩检验p = 0.001）。在Cox回归分析中，即使在调整协变量后，既往HHF仍与主要结局风险显著相关（风险比，1.344；95%置信区间，1.103 - 1.638；p = 0.003）。一项亚分析显示，射血分数（EF）≥50%的既往HHF组主要结局风险高于非既往HHF组，而EF < 50%的既往HHF组结局最差。
既往HHF病史与严重AS患者的不良结局相关，无论EF保留还是降低，即使在使用新一代装置进行TAVI术后也是如此。
