Changes and prognostic impact of noninvasive myocardial work indices in patients undergoing transcatheter aortic valve implantation.

IF 2.9 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Journal of Cardiovascular Medicine Pub Date : 2024-12-01 Epub Date: 2024-10-18 DOI:10.2459/JCM.0000000000001676
Federica Ilardi, Anna Franzone, Cristina Iapicca, Rachele Manzo, Domenico Angellotti, Dalila Nappa, Domenico S Castiello, Andrea Mariani, Ciro Santoro, Marisa Avvedimento, Attilio Leone, Antonello D'Andrea, Plinio Cirillo, Carmen Spaccarotella, Raffaele Piccolo, Giovanni Esposito
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Abstract

Purpose: The prognostic significance of noninvasive myocardial work (MW) indices in patients undergoing transcatheter aortic valve implantation (TAVI) has not been adequately examined.

Methods: We retrospectively selected 88 consecutive patients (mean age 79.9 ± 6.4 years, 40% males) with severe aortic stenosis scheduled for TAVI enrolled in the EffecTAVI registry. Exclusion criteria were prior valve surgery, atrial fibrillation, and left bundle branch block (LBBB) at baseline. Global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE) were measured by echocardiography at baseline and at 30 days. Accuracy of the noninvasive measures was assessed by invasive evaluation of MW.

Results: In the overall population, a significant reduction in GWI (2406 ± 567 vs. 2063 ± 515 mmHg% before and after TAVI respectively, P  < 0.001), GCW (2783 ± 616 vs. 2380 ± 495 mmHg%, P  < 0.001) and GWW (238 ± 203 vs. 186 ± 135 mmHg%, P  = 0.015) was observed at 30 days after TAVI. GWE improved only in patients who did not develop left ventricular dyssynchrony due to new-onset LBBB or pacemaker implantation following TAVI. In a multivariable Cox-regression analysis, GWE after TAVI (hazard ratio 0.892, 95% confidence interval 0.81-0.97; P  = 0.011) was the strongest predictor of adverse events (a composite of all-cause death, worsening of dyspnea, or rehospitalization for cardiovascular events) at 1-year follow-up.

Conclusions: TAVI results in significant changes in MW indices, including an early decrease in GWI, GCW and GWW, and an improvement in GWE in patients without left ventricle dyssynchrony. A GWE equal or less than 92% at 30 days is indicative of poor clinical outcomes at 1 year.

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经导管主动脉瓣植入术患者无创心肌工作指数的变化和对预后的影响。
目的:经导管主动脉瓣植入术(TAVI)患者的无创心肌工作(MW)指数的预后意义尚未得到充分研究:我们回顾性地选择了 88 例连续的重度主动脉瓣狭窄患者(平均年龄为 79.9 ± 6.4 岁,男性占 40%),这些患者均已加入 EffecTAVI 注册。排除标准是曾接受过瓣膜手术、心房颤动和基线左束支传导阻滞(LBBB)。在基线和30天时,通过超声心动图测量全局工作指数(GWI)、全局建设性工作(GCW)、全局浪费工作(GWW)和全局工作效率(GWE)。无创测量的准确性通过有创MW评估进行评估:结果:在所有人群中,TAVI前后的GWI均显著下降(TAVI前后分别为2406 ± 567 vs. 2063 ± 515 mmHg%, P 结论:TAVI会导致心肌收缩力的显著变化:TAVI 会导致 MW 指数发生重大变化,包括 GWI、GCW 和 GWW 的早期下降,以及无左心室不同步患者 GWE 的改善。30天时的GWE等于或低于92%表明1年后的临床效果不佳。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of Cardiovascular Medicine
Journal of Cardiovascular Medicine 医学-心血管系统
CiteScore
3.90
自引率
26.70%
发文量
189
审稿时长
6-12 weeks
期刊介绍: Journal of Cardiovascular Medicine is a monthly publication of the Italian Federation of Cardiology. It publishes original research articles, epidemiological studies, new methodological clinical approaches, case reports, design and goals of clinical trials, review articles, points of view, editorials and Images in cardiovascular medicine. Submitted articles undergo a preliminary review by the editor. Some articles may be returned to authors without further consideration. Those being considered for publication will undergo further assessment and peer-review by the editors and those invited to do so from a reviewer pool. ​
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