Shi Wence, Zhang Hongliang, Song Lei, Zou Tongqiang, Xie Lihua, Guan Changdong, Wang Moyang, Wu Yongjian
Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease Chinese Academy of Medical Science and Peking Union Medical College Beijing China.
Catheterization Laboratories, Fu Wai Hospital, National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China.
J Am Heart Assoc. 2025 Mar 4;14(5):e039346. doi: 10.1161/JAHA.124.039346. Epub 2025 Mar 3.
The coronary microcirculatory resistance index plays a crucial role in predicting patient prognosis. Coronary angiography-based methods for assessing coronary microcirculatory function offer advantages such as simplicity and cost-effectiveness. This study aimed to confirm the prognostic value of a novel angiographic microvascular resistance (AMR) index in patients undergoing transcatheter aortic valve replacement.
We prospectively included 335 patients with severe aortic stenosis who underwent transcatheter aortic valve replacement at Fuwai Hospital. The AMR was calculated based on coronary angiography performed before prosthetic valve implantation. Patients were divided into 2 groups based on an AMR cutoff value of 250: AMR ≤250 and AMR >250. The primary end point was major adverse cardiovascular events, defined as a composite of all-cause mortality, readmission for heart failure, and myocardial infarction. At a median follow-up of 40 months (interquartile range [IQR], 25-50), AMR was significantly higher in patients who experienced the primary end point (257 [IQR, 186-299] versus 226 [IQR, 177-264]; <0.001), identifying it as an independent risk factor for major adverse cardiovascular events, all-cause mortality, and new-onset atrial fibrillation. Kaplan-Meier analysis indicated that patients with AMR >250 had significantly lower event-free survival rates for major adverse cardiovascular events (62.9% versus 75.1%; hazard ratio, 1.94 [95% CI, 1.34-2.81]; log-rank <0.001), mainly driven by all-cause death (75.7% versus 83.4%, log-rank =0.018). Subgroup analyses supported these findings for major adverse cardiovascular events.
AMR is an independent predictor of adverse clinical outcomes after transcatheter aortic valve replacement. An AMR >250 can be used as a novel indicator for long-term prognostic management.
冠状动脉微血管阻力指数在预测患者预后方面起着关键作用。基于冠状动脉造影评估冠状动脉微血管功能的方法具有简单和成本效益高等优点。本研究旨在证实一种新型血管造影微血管阻力（AMR）指数在接受经导管主动脉瓣置换术患者中的预后价值。
我们前瞻性纳入了335例在阜外医院接受经导管主动脉瓣置换术的严重主动脉瓣狭窄患者。AMR基于人工瓣膜植入术前进行的冠状动脉造影计算得出。根据AMR临界值250将患者分为两组：AMR≤250和AMR>250。主要终点是主要不良心血管事件，定义为全因死亡率、因心力衰竭再次入院和心肌梗死的复合终点。在中位随访40个月（四分位间距[IQR]，25 - 50）时，发生主要终点事件的患者AMR显著更高（257[IQR，186 - 299]对226[IQR，177 - 264]；<0.001），表明其为主要不良心血管事件、全因死亡率和新发房颤的独立危险因素。Kaplan-Meier分析表明，AMR>250的患者主要不良心血管事件的无事件生存率显著更低（62.9%对75.1%；风险比，1.94[95%CI，1.34 - 2.81]；对数秩检验<0.001），主要由全因死亡驱动（75.7%对83.4%，对数秩检验=0.018）。亚组分析支持了这些关于主要不良心血管事件的研究结果。
AMR是经导管主动脉瓣置换术后不良临床结局的独立预测指标。AMR>250可作为长期预后管理的新指标。
