Edamura Shunsuke, Tamura Harutoshi, Watanabe Tetsu, Sugai Takayuki, Wanezaki Masahiro, Nishiyama Satoshi, Higuchi Ryosuke, Hagiya Kenichi, Takamisawa Itaru, Nanasato Mamoru, Iguchi Nobuo, Takayama Morimasa, Shimizu Jun, Doi Shinichiro, Okazaki Shinya, Ishiyama Masaki, Yokoyama Hiroaki, Takanashi Shuichiro, Fukutomi Motoki, Saji Mike, Watanabe Masafumi
Department of Cardiology, Pulmonology and Nephrology, Yamagata University School of Medicine, Yamagata, Japan.
Department of Cardiology, Sakakibara Heart Institute, Fuchu, Japan.
Heart Vessels. 2025 Jul 11. doi: 10.1007/s00380-025-02569-9.
Transcatheter aortic valve implantation (TAVI) has become available for elderly patients with aortic stenosis (AS). However, no markers have been established to predict prognosis after TAVI. Cardiac damage caused by AS progresses sequentially in most cases through the left ventricle, left atrium, and right ventricle. However, cardiac damage does not always progress sequentially. This study examined whether the burden of cardiac damage assessed by echocardiography predicts prognosis in patients with severe AS who underwent TAVI. We assessed patient data from a multicenter TAVI registry involving seven hospitals in Japan. Among 1,850 patients with severe AS, patients with preserved LV ejection fraction were included. We performed echocardiography before TAVI in 1,285 patients. The primary endpoint was cardiovascular (CV) events including CV deaths and rehospitalizations for heart failure. During a median follow-up of 741 days, 76 CV events occurred. A multivariate Cox-proportional hazards analysis revealed that four echocardiographic parameters, including tricuspid regurgitation pressure gradient, E/e', left atrial volume index, and left ventricular mass index were associated with CV events. We created a scoring system using these four echocardiographic parameters. The echocardiography-directed aortic stenosis score (EDA score) was computed by assigning one point each for the presence of abnormal parameters. The receiver operating characteristic curve of EDA score for CV events showed an area under the curve value of 0.74, a cutoff value of 3 points, a sensitivity value of 75%, and a specificity value of 63%. Kaplan-Meier analysis showed that CV event rates were significantly higher in patients with high EDA scores compared with those having low scores. Hazard ratio was 14.3-fold for the 3-point group and 26.6-fold for the 4-point group when compared with the 0-point group of patients. EDA score may be a feasible indicator for risk stratification in patients with severe AS who underwent TAVI.
经导管主动脉瓣植入术（TAVI）已可用于老年主动脉瓣狭窄（AS）患者。然而，尚未确立预测TAVI术后预后的标志物。在大多数情况下，AS所致的心脏损害会依次累及左心室、左心房和右心室。然而，心脏损害并不总是依次进展。本研究探讨了通过超声心动图评估的心脏损害负担是否能预测接受TAVI的重度AS患者的预后。我们评估了来自日本七家医院的多中心TAVI注册研究中的患者数据。在1850例重度AS患者中，纳入了左心室射血分数保留的患者。我们对1285例患者在TAVI术前进行了超声心动图检查。主要终点是心血管（CV）事件，包括CV死亡和因心力衰竭再次住院。在中位随访741天期间，发生了76例CV事件。多变量Cox比例风险分析显示，包括三尖瓣反流压力梯度、E/e'、左心房容积指数和左心室质量指数在内的四个超声心动图参数与CV事件相关。我们使用这四个超声心动图参数创建了一个评分系统。超声心动图指导的主动脉瓣狭窄评分（EDA评分）通过对每个异常参数存在情况给予1分来计算。CV事件的EDA评分的受试者工作特征曲线显示曲线下面积值为0.74，临界值为3分，敏感度值为75%，特异度值为63%。Kaplan-Meier分析显示，与低分患者相比，高EDA评分患者的CV事件发生率显著更高。与0分患者组相比，3分组的风险比为14.3倍，4分组为26.6倍。EDA评分可能是接受TAVI的重度AS患者进行风险分层的可行指标。
