经导管主动脉瓣置换术后左心室射血分数恶化的结局
Outcomes of Worsened Left Ventricular Ejection Fraction After Transcatheter Aortic Valve Replacement.
作者信息
Hu Ziyang, Wang Changjin, Luo Songyuan, Yang Bangyuan, Zheng Shengneng, Hu Xiaolu, Sun Yinghao, Chen Jiaohua, Fu Ming, Fan Ruixin, Luo Jianfang, Li Jie
机构信息
Department of Cardiology, Zhongshan Hospital of Traditional Chinese Medicine, Zhongshan, People's Republic of China.
Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, People's Republic of China.
出版信息
Int J Gen Med. 2025 Jan 27;18:437-445. doi: 10.2147/IJGM.S489952. eCollection 2025.
BACKGROUND
Left ventricular ejection fraction (LVEF) worsening after transcatheter aortic valve replacement (TAVR) was common in clinical practice. However, the effect of acute worsening LVEF is unclear.
METHODS
All consecutive patients who underwent TAVR between January 2016 and May 2022 were analyzed. Patients were divided into worsened LVEF and non-worsened LVEF according to whether or not they had an LVEF decline of ≥5% at discharge. Survival at follow-up was compared between two groups. Logistic regression analysis was used to determine independent predictors of worsening LVEF.
RESULTS
A total of 439 patients were included in the analysis, and 112 (25.5%) patients had worsened LVEF. Worsened LVEF was more common in patients with LVEF ≥50%. After multivariable logistic analysis, only baseline LVEF was associated with worsening LVEF [OR=1.06 (95% CI: 1.04-1.08), P < 0.001]. The decline in LVEF recovered to the baseline after one month. There were no significant differences in survival between patients with and without worsened LVEF (Log rank P = 0.48).
CONCLUSION
Acute worsening of LVEF after TAVR was not uncommon but did not affect survival. It could recover to baseline levels after one month. Routine post-TAVR echocardiography should focus on other metrics rather than acute LVEF changes.
背景
经导管主动脉瓣置换术（TAVR）后左心室射血分数（LVEF）恶化在临床实践中很常见。然而，LVEF急性恶化的影响尚不清楚。
方法
分析2016年1月至2022年5月期间连续接受TAVR的所有患者。根据出院时LVEF是否下降≥5%，将患者分为LVEF恶化组和未恶化组。比较两组随访期间的生存率。采用逻辑回归分析确定LVEF恶化的独立预测因素。
结果
共有439例患者纳入分析，其中112例（25.5%）患者LVEF恶化。LVEF≥50%的患者中LVEF恶化更为常见。多变量逻辑分析后，仅基线LVEF与LVEF恶化相关[比值比（OR）=1.06（95%置信区间：1.04-1.08），P<0.001]。LVEF下降在1个月后恢复至基线水平。LVEF恶化和未恶化的患者生存率无显著差异（对数秩检验P=0.48）。
结论
TAVR后LVEF急性恶化并不罕见，但不影响生存。1个月后可恢复至基线水平。TAVR术后常规超声心动图检查应关注其他指标而非LVEF的急性变化。
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