血流阶梯模式对保留左室射血分数的重度主动脉瓣狭窄经导管主动脉瓣置换术疗效的影响

IF 1.2 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS International heart journal Pub Date : 2024-11-30 Epub Date: 2024-11-14 DOI:10.1536/ihj.24-284
Yoshiyuki Yamashita, Massimo Baudo, Serge Sicouri, Mujtaba Zafar, Roberto Rodriguez, Eric M Gnall, Paul M Coady, Scott M Goldman, William A Gray, Basel Ramlawi
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引用次数: 0

摘要

这项回顾性研究的重点是2018年至2022年间接受新一代瓣膜(Sapien3/3 Ultra、Evolut Pro/Pro+/FX)TAVR手术的重度主动脉瓣狭窄(AS)和射血分数(pEF)保留患者(n = 781)。患者分为3组:正常血流高梯度组(NF-HG,搏出量指数≥35毫升/平方米且平均压力梯度≥40毫米汞柱或峰值速度≥4米/秒)、低血流高梯度组(LF-HG)和矛盾性低血流低梯度组(pLF-LG)。NF-HG 组、LF-HG 组和 pLF-LG 组分别有 525、188 和 68 名患者。整个队列的中位年龄为 82 岁,围手术期、1 年和 5 年死亡率分别为 1.8%、12% 和 48%。中位随访期为25个月(0-72个月),与NF-HG组相比,LF-HG组的全因死亡率以及全因死亡率和心衰再住院的复合死亡率明显更高,调整后的危险比(HR)分别为1.41(95%置信区间:1.02-1.92)和1.35(1.01-1.79)。相比之下,LF-NG组和pLF-LG组之间没有明显差异。在因严重AS和pEF而接受TAVR的患者中,与NF-HG AS相比,LF-HG AS的全因死亡风险和综合结局风险更高。
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Impact of Flow-Gradient Patterns on Outcomes of Transcatheter Aortic Valve Replacement for Severe Aortic Stenosis with Preserved Left Ventricular Ejection Fraction.

To compare the clinical outcomes of transcatheter aortic valve replacement (TAVR) in patients with severe aortic stenosis (AS) and preserved ejection fraction (pEF) according to flow-gradient status.This retrospective study focused on patients with severe AS and pEF (≥ 50%) undergoing TAVR with newer generation valves (Sapien3/3 Ultra, Evolut Pro/Pro+/FX) between 2018 and 2022 (n = 781). Patients were divided into 3 groups: normal-flow high-gradient (NF-HG, stroke volume index ≥ 35 mL/m2 and mean pressure gradient ≥ 40 mmHg or peak velocity ≥ 4 m/second), low-flow high-gradient (LF-HG), and paradoxical low-flow low-gradient (pLF-LG) groups. Multivariable Cox regression hazard model was used to adjust for confounders.There were 525, 188, and 68 patients in the NF-HG, LF-HG, and pLF-LG groups, respectively. For the entire cohort, the median age was 82 years, and the periprocedural, 1-year, and 5-year mortality rates were 1.8%, 12%, and 48%, respectively. During a median follow-up period of 25 (range 0-72) months, the rates of all-cause mortality and the composite of all-cause mortality and rehospitalization for heart failure were significantly higher in the LF-HG group compared with the NF-HG group, with adjusted hazard ratios (HRs) of 1.41 (95% confidence interval: 1.02-1.92) and 1.35 (1.01-1.79), respectively. In contrast, there were no significant differences between the LF-NG and pLF-LG groups.In patients undergoing TAVR for severe AS and pEF, LF-HG AS had a higher risk of all-cause mortality and the composite outcome compared with NF-HG AS.

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来源期刊
International heart journal
International heart journal 医学-心血管系统
CiteScore
2.50
自引率
6.70%
发文量
148
审稿时长
6-12 weeks
期刊介绍: Authors of research articles should disclose at the time of submission any financial arrangement they may have with a company whose product figures prominently in the submitted manuscript or with a company making a competing product. Such information will be held in confidence while the paper is under review and will not influence the editorial decision, but if the article is accepted for publication, the editors will usually discuss with the authors the manner in which such information is to be communicated to the reader.
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