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The Transcatheter Aortic Valve Replacement-Conduction Study: The Value of the His-Ventricular Interval in Risk Stratification for Post-TAVR Atrioventricular-Block 经导管主动脉瓣置换-传导研究:His 室间隔在经导管主动脉瓣置换术后房室传导阻滞风险分层中的价值
IF 1.4 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-01 DOI: 10.1016/j.shj.2024.100296

Background

There is no clear consensus regarding the optimal risk stratification of high-degree atrioventricular block (HDAVB) after transcatheter aortic valve replacement (TAVR).

Methods

This prospective study sought to determine the utility of the pre- and post-TAVR His-ventricular (HV) interval in the risk stratification of post-TAVR HDAVB. One hundred twenty-one patients underwent an electrophysiology study before and after TAVR. The primary outcome was HDAVB requiring pacemaker implantation within 30 days post-TAVR. A separate retrospective cohort was analyzed to determine the postoperative interval at which the risk of HDAVB is reduced to <5%.

Results

HDAVB occurred in 12 (10%) patients. Baseline right bundle branch block (RBBB) (odds ratio [OR]: 13.6), implant depth >4 mm (OR: 3.9), use of mechanically- or self-expanding valves (OR: 6.3), and post-TAVR HV > 65 ​ms (OR: 4.9) were associated with increased risk of HDAVB, whereas PR intervals and pre-TAVR HV were not. In patients without baseline RBBB or new persistent left bundle branch block (LBBB), not one patient with post-TAVR HV < 65 ​ms developed HDAVB. In the separate retrospective cohort (N = 1049), the risk of HDAVB is reduced (<5%) on postoperative days 4 and 3 in patients with pre-TAVR RBBB and post-TAVR persistent LBBB, respectively.

Conclusions

Baseline RBBB, new persistent LBBB, implant depth >4 mm, and a post-TAVR HV ≥ 65 ​ms were associated with a higher risk of post-TAVR HDAVB, whereas an HV ≤ 65 ​ms was associated with a lower risk. The pre-TAVR HV was not associated with our outcome, and the delta HV did not have practical incremental prognostic value. Among those without pre-TAVR RBBB or post-TAVR persistent LBBB, no patients with post-TAVR HV < 65 ​ms developed HDAVB.

背景关于经导管主动脉瓣置换术(TAVR)后高位房室传导阻滞(HDAVB)的最佳风险分层,目前还没有明确的共识。这项前瞻性研究旨在确定 TAVR 术前和术后 His-ventricular (HV) 间期在 TAVR 术后 HDAVB 风险分层中的作用。121名患者在TAVR前后接受了电生理学检查。主要结果是TAVR术后30天内需要植入起搏器的HDAVB。对另一个回顾性队列进行了分析,以确定术后HDAVB风险降至<5%的间隔时间。基线右束支传导阻滞(RBBB)(赔率[OR]:13.6)、植入深度4毫米(OR:3.9)、使用机械瓣膜或自扩张瓣膜(OR:6.3)以及TAVR术后HV 65毫秒(OR:4.9)与HDAVB风险增加有关,而PR间期和TAVR术前HV则无关。在没有基线RBBB或新的持续性左束支传导阻滞(LBBB)的患者中,没有一名TAVR后HV超过65毫秒的患者发生HDAVB。在单独的回顾性队列(N = 1049)中,TAVR前RBBB和TAVR后持续性LBBB患者在术后第4天和第3天发生HDAVB的风险分别降低了(<5%)。结论基线RBBB、新的持续性LBBB、植入深度>4 mm和TAVR后HV≥65 ms与TAVR后发生HDAVB的较高风险相关,而HV≤65 ms与较低风险相关。TAVR前的HV与我们的结果无关,δHV也没有实际的增量预后价值。在没有TAVR前RBBB或TAVR后持续LBBB的患者中,没有TAVR后HV < 65 ms的患者发展为HDAVB。
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引用次数: 0
Addressing the Occupational Risk of Radiation Exposure in the Evolving Field of Interventional Echocardiography 在不断发展的介入超声心动图领域应对辐射职业风险
IF 1.4 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-01 DOI: 10.1016/j.shj.2024.100328
Philipp Lauten MD, Harald Lapp MD, Björn Goebel MD

Interventional echocardiography (IE) is a relatively new subspecialty in the field of cardiology that has rapidly evolved to occupy a critical role in the treatment of structural heart disease. Despite this, clear competency guidelines are only now being issued, and, of pressing importance, the health risks associated with the profession, particularly occupational radiation exposure, still need to be recognized and appropriately addressed for both specialists and trainees in IE as well as for supporting sonographers. This review will briefly discuss the extensive training interventional echocardiographers need in advanced imaging modalities and will then present standard measures as well as possible innovative devices that can be implemented to reduce ionizing radiation exposure for those working in the field of IE.

介入超声心动图(IE)是心脏病学领域中一个相对较新的亚专科,它发展迅速,在治疗结构性心脏病方面发挥着至关重要的作用。尽管如此,明确的能力指南现在才刚刚发布,而且更重要的是,与该专业相关的健康风险,尤其是职业性辐射暴露,仍需得到 IE 专家和受训者以及辅助超声技师的认可和适当处理。本综述将简要讨论介入超声心动图技师在高级成像模式方面需要接受的广泛培训,然后介绍可用于减少 IE 领域工作人员电离辐射暴露的标准措施和可能的创新设备。
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引用次数: 0
Percutaneous Closure of a Left Ventricular Pseudoaneurysm 经皮闭合左心室假性动脉瘤
IF 1.4 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-07-01 DOI: 10.1016/j.shj.2024.100320
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引用次数: 0
Thirty-Day High-Grade Aortic Valve Block Post-Transcatheter Aortic Valve Replacement in Patients Discharged on Heart Rhythm Monitor 接受经导管主动脉瓣置换术的出院患者在术后 30 天内出现的高分级主动脉瓣阻滞
IF 1.4 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-07-01 DOI: 10.1016/j.shj.2024.100317

Background

Conduction disease is an important and common complication post-transcatheter aortic valve replacement (TAVR). Previously, we developed a conduction disease risk stratification and management protocol post-TAVR. This study aims to evaluate high-grade aortic valve block (HAVB) incidence and risk factors in a large cohort undergoing ambulatory cardiac monitoring post-TAVR according to conduction risk grouping.

Methods

This single-center, retrospective study evaluated all patients discharged on ambulatory cardiac monitoring between 2016 and 2021 and stratified them into 3 groups based on electrocardiogram predictors of HAVB risk (group 1 [low], group 2 [intermediate], and group 3 [high]). HAVB was defined as ≥2 consecutive nonconducted P waves in sinus rhythm or bradycardia <50 beats/minute with a fixed rate for atrial fibrillation/flutter. Descriptive statistics were used to show the incidence and timeline, while logistic regression was utilized to evaluate predictors of HAVB.

Results

Five hundred twenty-eight patients were included (median age 80 years [74-85]; 43.8% female). Forty-one patients (7.8%) developed HAVB during ambulatory monitoring (68% were asymptomatic). Over a median follow-up of 2 years (1.3-2.7), the overall mortality rate was 15.0% (30-day mortality rate of 0.57%, n = 3). Risk factors for HAVB were male sex (odds ratio [OR] = 2.46, p = 0.02, 95% CI = 1.21-5.43), baseline right bundle branch block (OR = 2.80, p = 0.01, 95% CI = 1.17-6.19), and post-TAVR QRS >150 ​ms (OR = 2.16, p = 0.03, 95% CI = 1.01-4.40). The negative predictive value for patients in groups 1 and 2 for 30-day HAVB was 95.0 and 93.8%, respectively.

Conclusions

The risk of 30-day HAVB post-TAVR on ambulatory monitoring post-TAVR varies according to post-TAVR electrocardiogram findings, and a 3-group algorithm effectively identifies groups with a low negative predictive value for HAVB.

背景传导疾病是经导管主动脉瓣置换术(TAVR)术后重要而常见的并发症。此前,我们制定了经导管主动脉瓣置换术后传导疾病风险分层和管理方案。这项单中心回顾性研究评估了 2016 年至 2021 年期间接受非卧床心脏监护出院的所有患者,并根据心电图预测的 HAVB 风险将其分为 3 组(第 1 组[低]、第 2 组[中]和第 3 组[高])。HAVB的定义是窦性心律或心动过缓<50次/分(心房颤动/扑动的固定频率)时连续出现≥2个非传导性P波。结果纳入了 528 名患者(中位年龄 80 岁 [74-85];43.8% 为女性)。41 名患者(7.8%)在流动监测期间出现了 HAVB(68% 无症状)。中位随访时间为 2 年(1.3-2.7 年),总死亡率为 15.0%(30 天死亡率为 0.57%,n = 3)。HAVB 的风险因素为男性(几率比 [OR] = 2.46,P = 0.02,95% CI = 1.21-5.43)、基线右束支传导阻滞(OR = 2.80,P = 0.01,95% CI = 1.17-6.19)和 TAVR 后 QRS >150 ms(OR = 2.16,P = 0.03,95% CI = 1.01-4.40)。结论 TAVR 术后非卧床监测中,TAVR 术后 30 天 HAVB 的风险因 TAVR 术后心电图结果而异,3 组算法可有效识别 HAVB 阴性预测值较低的组别。
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引用次数: 0
Medical Therapy for Heart Failure in Adult Congenital Heart Disease Patients 成人先天性心脏病患者心力衰竭的药物治疗
IF 1.4 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-07-01 DOI: 10.1016/j.shj.2024.100297

There is an increasing recognition of heart failure among adults with congenital heart disease as a result of the advancements in medical, interventional, and surgical care. The long-term consequences of palliative therapy in infancy, childhood, and adulthood are incompletely understood. Medical therapy, including pharmacologic and device therapies, have been used for the treatment of heart failure. This review summarizes care strategies that have been applied within the spectrum of adults with congenital heart disease, including failing systemic ventricles, single ventricles, and Eisenmenger physiology.

随着医疗、介入治疗和外科治疗的进步,人们越来越认识到先天性心脏病成人患者的心力衰竭问题。人们对婴儿期、儿童期和成年期姑息治疗的长期后果尚不完全了解。医学疗法,包括药物疗法和器械疗法,已被用于治疗心力衰竭。本综述总结了适用于先天性心脏病成人患者的护理策略,包括系统性心室衰竭、单心室和艾森曼格生理学。
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引用次数: 0
Predictors and Trends of New Permanent Pacemaker Implantation: A Subanalysis of the International Navitor IDE Study 新植入永久起搏器的预测因素和趋势:国际 Navitor IDE 研究子分析
IF 1.4 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-07-01 DOI: 10.1016/j.shj.2024.100293

Background

The Navitor Investigational Device Exemption (IDE) study is a prospective, multicenter, global study assessing the safety and effectiveness of the Navitor valve in a population with severe, symptomatic aortic stenosis who are at high and extreme surgical risk. The impact of pre-existing conduction abnormalities and implantation technique on new permanent pacemaker implantation (PPI) for the Navitor platform is not fully understood. Therefore, the goal of this analysis was to investigate the associations between patient and procedural factors and the 30-day new PPI rate.

Methods

A total of 260 patients who underwent implantation of a Navitor valve in the Navitor IDE study were reviewed. Patients with preprocedural permanent pacemakers (n = 28) were excluded. Baseline risk factors were assessed for statistical significance. Multivariable logistic regression analyses were performed to identify independent predictors of new PPI.

Results

Mean age of the pacemaker-naïve population was 83.3 ± 5.2 years, 58.6% were female, average Society of Thoracic Surgeons score was 3.8% ± 1.9%, median frailty score was 1 (interquartile range 1, 2), and 17.7% were deemed at extreme surgical risk. Pre-existing first-degree atrioventricular block and right bundle branch block significantly increased the risk of new PPI postimplantation, whereas left bundle branch block did not. Membranous septum length in relation to noncoronary cusp implant depth was a significant predictor of new PPI, with higher rates of new PPI observed when noncoronary cusp implant depth exceeded membranous septum length. Analysis of implant depth alone revealed deeper implants were associated with a higher rate of new PPI, regardless of patient baseline conduction abnormality.

Conclusions

The 30-day rate of new PPI in the Navitor IDE study is associated with patient pre-existing baseline conduction disturbances and implantation depth.

背景Navitor研究性设备豁免(IDE)研究是一项前瞻性、多中心、全球性研究,目的是评估Navitor瓣膜在有症状的重度主动脉瓣狭窄患者中的安全性和有效性,这些患者面临极高的手术风险。目前还不完全清楚已有的传导异常和植入技术对 Navitor 平台新永久起搏器植入(PPI)的影响。因此,本分析的目的是研究患者和手术因素与 30 天新的 PPI 率之间的关系。方法回顾了 Navitor IDE 研究中接受 Navitor 瓣膜植入术的 260 例患者。排除了术前植入永久起搏器的患者(28 例)。对基线风险因素进行了统计学意义评估。结果 未安装起搏器患者的平均年龄为 83.3 ± 5.2 岁,58.6% 为女性,胸外科医师协会平均评分为 3.8% ± 1.9%,虚弱评分中位数为 1(四分位间范围为 1、2),17.7% 被认为具有极高的手术风险。植入前存在的一级房室传导阻滞和右束支传导阻滞会显著增加植入后出现新的PPI的风险,而左束支传导阻滞则不会。膜室间隔长度与非冠状动脉尖植入深度的关系是新发 PPI 的重要预测因素,当非冠状动脉尖植入深度超过膜室间隔长度时,新发 PPI 的发生率更高。结论 Navitor IDE 研究中的 30 天新发 PPI 率与患者原有的基线传导障碍和植入深度有关。
{"title":"Predictors and Trends of New Permanent Pacemaker Implantation: A Subanalysis of the International Navitor IDE Study","authors":"","doi":"10.1016/j.shj.2024.100293","DOIUrl":"10.1016/j.shj.2024.100293","url":null,"abstract":"<div><h3>Background</h3><p>The Navitor Investigational Device Exemption (IDE) study is a prospective, multicenter, global study assessing the safety and effectiveness of the Navitor valve in a population with severe, symptomatic aortic stenosis who are at high and extreme surgical risk. The impact of pre-existing conduction abnormalities and implantation technique on new permanent pacemaker implantation (PPI) for the Navitor platform is not fully understood. Therefore, the goal of this analysis was to investigate the associations between patient and procedural factors and the 30-day new PPI rate.</p></div><div><h3>Methods</h3><p>A total of 260 patients who underwent implantation of a Navitor valve in the Navitor IDE study were reviewed. Patients with preprocedural permanent pacemakers (n = 28) were excluded. Baseline risk factors were assessed for statistical significance. Multivariable logistic regression analyses were performed to identify independent predictors of new PPI.</p></div><div><h3>Results</h3><p>Mean age of the pacemaker-naïve population was 83.3 ± 5.2 years, 58.6% were female, average Society of Thoracic Surgeons score was 3.8% ± 1.9%, median frailty score was 1 (interquartile range 1, 2), and 17.7% were deemed at extreme surgical risk. Pre-existing first-degree atrioventricular block and right bundle branch block significantly increased the risk of new PPI postimplantation, whereas left bundle branch block did not. Membranous septum length in relation to noncoronary cusp implant depth was a significant predictor of new PPI, with higher rates of new PPI observed when noncoronary cusp implant depth exceeded membranous septum length. Analysis of implant depth alone revealed deeper implants were associated with a higher rate of new PPI, regardless of patient baseline conduction abnormality.</p></div><div><h3>Conclusions</h3><p>The 30-day rate of new PPI in the Navitor IDE study is associated with patient pre-existing baseline conduction disturbances and implantation depth.</p></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"8 4","pages":"Article 100293"},"PeriodicalIF":1.4,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2474870624000241/pdfft?md5=f090c0fa12f2f2db915e5e42d33854cd&pid=1-s2.0-S2474870624000241-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140271923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Multiple Valvular Heart Disease in the Transcatheter Era: A State-of-the-Art Review 经导管时代的多发性瓣膜性心脏病:最新进展回顾
IF 1.4 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-07-01 DOI: 10.1016/j.shj.2024.100301

Although existing guidelines offer strong recommendations for single valvular dysfunction, the growing prevalence of multiple valvular heart disease (MVHD) in our aging population is challenging the clarity of clinical guidance. Traditional diagnostic modalities, such as echocardiography, face inherent constraints in precisely quantifying valvular dysfunction due to the hemodynamic interactions that occur with multiple valve involvement. Therefore, many patients with MVHD present at a later stage in their disease course and with an elevated surgical risk. The expansion of transcatheter therapy for the treatment of valvular heart disease has added new opportunities for higher-risk patients. However, the impact of isolated valve therapies on patients with MVHD is still not well understood. This review focuses on the etiology, diagnostic challenges, and therapeutic considerations for some of the most common concomitant valvular abnormalities that occur in our daily clinic population.

尽管现有指南针对单瓣膜功能障碍提出了强有力的建议,但在我们的老龄化人口中,多瓣膜心脏病(MVHD)的发病率越来越高,这对临床指南的清晰性提出了挑战。由于多瓣膜受累时血流动力学的相互作用,超声心动图等传统诊断方法在精确量化瓣膜功能障碍方面面临固有的限制。因此,许多 MVHD 患者的病程较晚,手术风险较高。治疗瓣膜性心脏病的经导管疗法的推广为高风险患者增加了新的机会。然而,孤立瓣膜疗法对 MVHD 患者的影响仍不甚了解。本综述将重点讨论日常门诊中最常见的一些并发瓣膜异常的病因、诊断难题和治疗注意事项。
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引用次数: 0
Frailty: A Nebulous Concept? 虚弱:一个模糊的概念?
IF 1.4 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-07-01 DOI: 10.1016/j.shj.2024.100337
Anthony DeMaria MD
{"title":"Frailty: A Nebulous Concept?","authors":"Anthony DeMaria MD","doi":"10.1016/j.shj.2024.100337","DOIUrl":"10.1016/j.shj.2024.100337","url":null,"abstract":"","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"8 4","pages":"Article 100337"},"PeriodicalIF":1.4,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S247487062400085X/pdfft?md5=b45864dffb2c23006de48b30d278bc46&pid=1-s2.0-S247487062400085X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141622288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Simultaneous Transcatheter Aortic and Mitral Native Valve Replacement: A Step-by-Step Procedural Approach 同步经导管主动脉瓣和二尖瓣原位瓣膜置换术:循序渐进的手术方法
IF 1.4 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-07-01 DOI: 10.1016/j.shj.2024.100295

Multivalvular heart disease (MVHD) is present in one-third of patients with valvular heart disease (VHD). Compared to single VHD patients, these patients have a more significant hemodynamic impact and are often left under medical treatment. Most importantly, when undergoing multiple valve interventions, they show worse rates of heart failure and mortality. The guidelines-supported interventions in patients with MVHD in combined aortic regurgitation and mitral stenosis include percutaneous mitral balloon commissurotomy, open mitral commissurotomy, or surgical mitral valve replacement followed by transcatheter or surgical aortic valve replacement, trying to minimize the increased mortality risk of double-valve replacement. Simultaneous transcatheter valve replacement (STVR) for native MVHD is still off-label and not yet considered in clinical guidelines since the evidence of its results is limited to a few cases reported worldwide. However, fully percutaneous transfemoral STVR seems promising for MVHD patients thanks to its minimal invasiveness, the continuous improvement of the transcatheter heart valve devices, the likely shorter length of stay and the fastest recovery. To our knowledge, this is the first case ever reported of fully percutaneous STVR for native MVHD in aortic regurgitation and mitral stenosis. Deep understanding of both pathologies and their interactions, not only from a pathological point of view but from the procedural planning and procedural steps point of view is mandatory. Hereby we present the specific STVR procedural planning considerations, a step-by-step guide on how to perform an aortic and mitral STVR and its critical considerations, as well as the procedural and follow-up results.

三分之一的瓣膜性心脏病(VHD)患者患有多瓣膜性心脏病(MVHD)。与单瓣膜病患者相比,这些患者对血液动力学的影响更大,通常只能接受药物治疗。最重要的是,在接受多瓣膜介入治疗时,他们的心力衰竭率和死亡率都会更高。指南支持对合并主动脉瓣反流和二尖瓣狭窄的 MVHD 患者进行的介入治疗包括经皮二尖瓣球囊瓣膜切开术、开放式二尖瓣瓣膜切开术或手术二尖瓣置换术,然后进行经导管或手术主动脉瓣置换术,以尽量降低双瓣置换术增加的死亡率风险。原发性二尖瓣置换术(MVHD)的同步经导管瓣膜置换术(STVR)仍未列入临床指南,因为其结果的证据仅限于全球报道的少数病例。然而,全经皮经股动脉瓣膜置换术因其微创性、经导管心脏瓣膜装置的不断改进、住院时间可能更短以及恢复最快等优点,似乎很有希望用于 MVHD 患者。据我们所知,这是首例完全经皮 STVR 治疗主动脉瓣反流和二尖瓣狭窄的原发性 MVHD 病例。不仅要从病理学角度,而且要从手术计划和手术步骤的角度深入了解这两种病变及其相互作用。在此,我们将介绍具体的 STVR 程序规划注意事项、如何进行主动脉和二尖瓣 STVR 的分步指南及其关键注意事项,以及程序和随访结果。
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引用次数: 0
Left and Right Ventricular Hemodynamic Response After Transcatheter Mitral Valve Replacement 经导管二尖瓣置换术后的左右心室血流动力学反应
IF 1.4 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-07-01 DOI: 10.1016/j.shj.2024.100322

Background

Transcatheter mitral valve replacement (TMVR) represents a novel treatment option for patients with mitral regurgitation (MR), but little is known about the hemodynamic impact of MR elimination following TMVR. We sought to investigate the hemodynamic impact of TMVR on left ventricular (LV) and right ventricular (RV) function using noninvasive pressure-volume loops.

Methods

All consecutive patients undergoing TMVR with dedicated devices between May 2016 and August 2022 were enrolled. The end-diastolic and end-systolic pressure-volume relationships were estimated from 26 patients using single-beat echocardiographic measurements at baseline and after TMVR at discharge. RV function was assessed by RV-pulmonary artery (PA) coupling and RV fractional area change. One-year follow-up was available for 19 patients. The prognostic impact of calculated end-diastolic volume at an end-diastolic pressure of 20 mmHg (VPed20) reduction was assessed by Cox regression.

Results

A total of 26 patients (77.0 years [interquartile range 73.9-80.1], N = 17 [65.4%] male) with successful TMVR were included (secondary MR [N = 21, 80.8%]; median LV ejection fraction was 37.0% [interquartile range 30.7-50.7]). At discharge, a decrease in VPed20 (p < 0.001) indicating leftward shift of end-diastolic pressure-volume relationship, and an increase of the end-systolic elastance slope (p = 0.007) were observed after TMVR. No changes were observed for RV-PA coupling (p = 0.19) and RV fractional area change (p = 0.22). At 1-year follow-up, LV contractility (end-systolic elastance) and RV-PA coupling remained stable. Vped20 reduction at discharge was significantly associated with 1-year all-cause mortality or heart failure hospitalization (hazard ratio 0.16, 95% CI 0.04-0.71, p = 0.016).

Conclusions

Noninvasive assessment of pressure-volume loops demonstrated early LV reverse remodeling and improved LV contractility, while RV performance was preserved. These results indicate the potential prognostic impact of complete MR elimination after TMVR.

背景导管二尖瓣置换术(TMVR)是二尖瓣反流(MR)患者的一种新型治疗方法,但人们对 TMVR 术后消除 MR 对血流动力学的影响知之甚少。我们试图利用无创压力-容积环路研究 TMVR 对左心室(LV)和右心室(RV)功能的血流动力学影响。方法纳入了 2016 年 5 月至 2022 年 8 月期间使用专用装置接受 TMVR 的所有连续患者。利用基线时和出院时 TMVR 后的单次搏动超声心动图测量估算了 26 名患者的舒张末和收缩末压力-容积关系。RV功能通过RV-肺动脉(PA)耦合和RV分数面积变化进行评估。对 19 名患者进行了为期一年的随访。结果 共纳入了 26 例成功进行 TMVR 的患者(77.0 岁 [四分位数范围 73.9-80.1],男性 17 例 [65.4%])(继发性 MR [21 例,80.8%];左心室射血分数中位数为 37.0% [四分位数范围 30.7-50.7])。出院时,TMVR 后观察到 VPed20 下降(p < 0.001),表明舒张末期压力-容积关系左移,收缩末期弹性斜率增加(p = 0.007)。RV-PA 耦合(p = 0.19)和 RV 分数面积变化(p = 0.22)均未观察到变化。随访 1 年时,左心室收缩力(收缩末期弹性)和 RV-PA 耦合保持稳定。出院时 Vped20 减少与 1 年全因死亡率或心衰住院率显著相关(危险比 0.16,95% CI 0.04-0.71,p = 0.016)。结论压力-容积环路的无创评估显示 LV 早期逆向重塑和 LV 收缩力改善,而 RV 性能保持不变。这些结果表明了 TMVR 后完全消除 MR 对预后的潜在影响。
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引用次数: 0
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Structural Heart
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