Miyahara Daisuke, Izumo Masaki, Sato Yukio, Shoji Tatsuro, Murata Risako, Oda Ryutaro, Okuno Taishi, Kuwata Shingo, Akashi Yoshihiro J
Department of Cardiology, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-Ku, Kawasaki, 216-8511, Japan.
J Echocardiogr. 2025 Jun;23(2):99-108. doi: 10.1007/s12574-024-00664-w. Epub 2024 Oct 21.
Evidence for risk stratification using exercise stress echocardiography (ESE) in patients undergoing transcatheter aortic valve implantation (TAVI) for severe aortic stenosis (AS) is currently lacking. Cardiac power output (CPO) has demonstrated prognostic value in patients undergoing TAVI for severe AS. This study investigated prognoses in patients undergoing TAVI for severe AS and to explore the additional information that ESE can provide for risk stratification.
In this retrospective observational study, we included 96 consecutive patients who underwent TAVI for severe AS and patients with preserved left ventricular (LV) ejection fraction (≥ 50%) who underwent ESE at 3-6 months after TAVI. CPO was calculated as 0.222 × cardiac output × mean blood pressure/LV mass, where 0.222 was the conversion constant to W/100 g of the LV myocardium. All patients were followed up for all-cause mortality and hospitalization for heart failure.
Of the 96 patients, 3 were excluded and 93 patients (82.0 years; 45.2% male) were included in this study. During a median follow-up period of 1446 (1271-1825) days, the composite end point was reached in 17 patients. Multivariable Cox regression analysis revealed that CPO at rest and the change in CPO from rest to exercise (ΔCPO) were independently associated with the composite end point (hazard ratio = 0.278, p = 0.023). The addition of ΔCPO resulted in an incremental value of the model containing clinical and resting echocardiography variables (p = 0.030).
This study suggests that resting CPO and exercise-induced changes in CPO are useful for risk stratification of patients undergoing TAVI for severe AS.
目前缺乏在严重主动脉瓣狭窄（AS）患者行经导管主动脉瓣植入术（TAVI）时使用运动负荷超声心动图（ESE）进行风险分层的证据。心脏功率输出（CPO）已在严重AS患者接受TAVI治疗中显示出预后价值。本研究调查了严重AS患者接受TAVI治疗后的预后情况，并探索ESE可为风险分层提供的额外信息。
在这项回顾性观察研究中，我们纳入了96例连续接受严重AS的TAVI治疗的患者以及左心室（LV）射血分数保留（≥50%）且在TAVI术后3至6个月接受ESE检查的患者。CPO计算公式为0.222×心输出量×平均血压/LV质量，其中0.222为转换常数，单位为W/100g LV心肌。所有患者均随访全因死亡率和因心力衰竭住院情况。
96例患者中，3例被排除，93例患者（82.0岁；45.2%为男性）纳入本研究。在中位随访期1446（1271 - 1825）天内，17例患者达到复合终点。多变量Cox回归分析显示，静息CPO以及静息至运动时CPO的变化（ΔCPO）与复合终点独立相关（风险比 = 0.278，p = 0.023）。加入ΔCPO后，包含临床和静息超声心动图变量的模型有增量价值（p = 0.030）。
本研究表明，静息CPO和运动引起的CPO变化对严重AS患者接受TAVI治疗的风险分层有用。
