Avidan Yuval, Aker Amir, Naoum Ibrahim, Stein Nili, Kassem Sameer
Department of Cardiology, Lady Davis Carmel Medical Center, Haifa, Israel.
Department of Community Medicine and Epidemiology, Statistical Unit, Lady Davis Carmel Medical Center, Haifa, Israel.
Int J Cardiol Heart Vasc. 2025 Jan 2;56:101596. doi: 10.1016/j.ijcha.2024.101596. eCollection 2025 Feb.
Aortic stenosis (AS) is treated through transcatheter aortic valve implantation (TAVI) or surgical aortic valve replacement (SAVR), with diabetes being prevalent among these patients. Inflammation participates in the pathogenesis of AS, and emerging evidence suggests that TAVI may exert anti-inflammatory effects. Given the established link between diabetes and inflammation, we sought to evaluate the impact of aortic valve replacement (AVR) on glycemic control.
Data from 10,129 consecutive patients undergoing either TAVI or SAVR between January 2010 and January 2022 were analyzed. Of these, 3,783 with diabetes had available pre- and post-procedural glycated hemoglobin (HbA1c) measurements. Analysis of 1,284 individuals with HbA1c ≥ 7 % was conducted. Propensity-score matching produced two well-matched cohorts of 266 TAVI and SAVR patients, enabling comparison of periprocedural HbA1c.
In the total cohort (n = 1,284), HbA1c decreased from 8.15 ± 1.12 to 7.88 ± 1.38 (p < 0.001). After matching, the TAVI group showed a significant reduction from 8.31 ± 1.31 to 7.86 ± 1.56 (p < 0.001), while a modest decrease from 8.33 ± 1.33 to 8.15 ± 1.61 (p = 0.046) was observed in SAVR group. The TAVI group showed a trend toward a greater percentage change in HbA1c (p = 0.051). Clinically meaningful improvement in HbA1c (≥ 0.3 %) was similar between TAVI (53.1 %) and SAVR (45.6 %) patients (OR = 1.34, 95 % CI 0.93-1.95).
Management of AS through either intervention improved post-procedural glycemia in patients with uncontrolled diabetes. The extent of glycemic improvement was more pronounced with TAVI. Further investigations through controlled and prospective studies could provide more conclusive insights into this matter.
主动脉瓣狭窄（AS）通过经导管主动脉瓣植入术（TAVI）或外科主动脉瓣置换术（SAVR）进行治疗，糖尿病在这些患者中很常见。炎症参与AS的发病机制，新出现的证据表明TAVI可能具有抗炎作用。鉴于糖尿病与炎症之间已确立的联系，我们试图评估主动脉瓣置换术（AVR）对血糖控制的影响。
分析了2010年1月至2022年1月期间连续接受TAVI或SAVR治疗的10129例患者的数据。其中，3783例糖尿病患者有术前和术后糖化血红蛋白（HbA1c）测量值。对1284例HbA1c≥7%的个体进行了分析。倾向评分匹配产生了两个匹配良好的队列，分别为266例TAVI患者和266例SAVR患者，从而能够比较围手术期HbA1c。
在整个队列（n = 1284）中，HbA1c从8.15±1.12降至7.88±1.38（p < 0.001）。匹配后，TAVI组从8.31±1.31显著降至7.86±1.56（p < 0.001），而SAVR组从8.33±1.33略有下降至8.15±1.61（p = 0.046）。TAVI组HbA1c的百分比变化趋势更大（p = 0.051）。TAVI组（53.1%）和SAVR组（45.6%）患者HbA1c的临床有意义改善（≥0.3%）相似（OR = 1.34，95%CI 0.93 - 1.95）。
通过任何一种干预措施治疗AS均可改善未控制糖尿病患者术后的血糖水平。TAVI对血糖的改善程度更为明显。通过对照和前瞻性研究进行进一步调查可以为这个问题提供更确凿的见解。
