Schmitt Ramona, Ressler Nils, Kaier Klaus, Brado Johannes, Hein Manuel, Soschynski Martin, Westermann Dirk, Neumann Franz-Josef, Breitbart Philipp, Ruile Philipp
Department of Cardiology and Angiology, Faculty of Medicine, Medical Center, University of Freiburg, University of Freiburg, Südring 15, 79189, Bad Krozingen, Germany.
Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany.
Clin Res Cardiol. 2025 Jun 23. doi: 10.1007/s00392-025-02701-9.
Patient-prosthesis mismatch (PPM) after trans-catheter aortic valve implantation (TAVI) is a risk factor for heart failure and mortality. Assessment of PPM using transthoracic echocardiography (TTE) and presence of hypo-attenuated leaflet thickening (HALT) may lead to overestimation. Our study aimed to assess the incidence of PPM using TTE and CTA after exclusion of patients with HALT and to evaluate predictors analyzing stent geometry.
444 patients were analyzed. PPM was calculated using the continuity equation from TTE (TTE-PPM) and CTA (CT-PPM). Regression analyses were conducted for the endpoint effective orifice area (EOA) as surrogate for PPM.
Severe PPM was detected in 4.5% using TTE-PPM and in 0.5% using CT-PPM. Body mass index (BMI) was identified as a predictor for a smaller EOA in each model (p < 0.001). Using TTE-PPM and CT-PPM, a smaller valve diameter was associated with a smaller effective orifice area (EOA) (p < 0.001). Presence of a balloon-expanding valve was associated with a smaller EOA using CT-PPM (p = 0.033). Stent geometry did not influence the EOA (p > 0.05 each model). EOA did not influence overall survival (p > 0.05 each model).
The incidence of severe PPM was very low and only predicted by BMI in each assessment model. Stent geometry did not influence the incidence of PPM. Overall survival was not influenced by a smaller EOA.
经导管主动脉瓣植入术（TAVI）后患者-人工瓣膜不匹配（PPM）是心力衰竭和死亡的危险因素。使用经胸超声心动图（TTE）评估PPM以及存在低衰减瓣叶增厚（HALT）可能会导致高估。我们的研究旨在排除有HALT的患者后，使用TTE和CTA评估PPM的发生率，并通过分析支架几何形状来评估预测因素。
分析了444例患者。使用TTE（TTE-PPM）和CTA（CT-PPM）的连续性方程计算PPM。对作为PPM替代指标的终点有效瓣口面积（EOA）进行回归分析。
使用TTE-PPM检测到严重PPM的比例为4.5%，使用CT-PPM检测到的比例为0.5%。在每个模型中，体重指数（BMI）被确定为较小EOA的预测因素（p < 0.001）。使用TTE-PPM和CT-PPM时，较小的瓣膜直径与较小的有效瓣口面积（EOA）相关（p < 0.001）。使用CT-PPM时，球囊扩张瓣膜的存在与较小的EOA相关（p = 0.033）。支架几何形状不影响EOA（每个模型p > 0.05）。EOA不影响总生存率（每个模型p > 0.05）。
在每个评估模型中，严重PPM的发生率非常低，且仅由BMI预测。支架几何形状不影响PPM的发生率。较小的EOA不影响总生存率。
