Paradoxical prognostic impact of severe aortic stenosis following trans-catheter aortic valve implantation

IF 2.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of cardiology Pub Date : 2024-04-04 DOI:10.1016/j.jjcc.2024.03.010

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引用次数: 0

Abstract

Background

Aortic valve replacement is recommended for patients with “very severe” aortic stenosis (AS), irrespective of symptomatic manifestation. Nonetheless, the prognostic ramifications of “very severe” AS, as opposed to “severe” AS, subsequent to trans-catheter aortic valve implantation (TAVI) remain enigmatic.

Methods

We enrolled consecutive patients who received TAVI at our institute between May 2015 and April 2021. We scrutinized the impact of baseline “very severe” AS upon 3-year all-cause death or heart failure hospitalization following TAVI, in comparison to “severe” AS.

Results

A total of 239 patients (84.8 ± 5.4 years old, 58 men) were included. Baseline “very severe” AS was observed in 65 (27 %) patients, who exhibited more advanced hypertrophy and higher B-type natriuretic peptide levels compared to those with “severe” AS (p < 0.05 for both). Baseline “very severe” AS was paradoxically associated with higher freedom from the primary endpoint following TAVI compared to those with “severe” AS (p = 0.01).

Conclusions

The presence of baseline “very severe” AS was paradoxically associated with improved clinical outcomes subsequent to TAVI, in contrast to the cases of “severe” AS.

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经导管主动脉瓣植入术后重度主动脉瓣狭窄对预后的反常影响

对于 "非常严重 "的主动脉瓣狭窄（AS）患者，无论症状表现如何，都建议进行主动脉瓣置换术。然而，与 "重度 "主动脉瓣狭窄相比，"极重度 "主动脉瓣狭窄患者在接受经导管主动脉瓣植入术（TAVI）后的预后仍是个谜。我们招募了2015年5月至2021年4月期间在我院接受TAVI的连续患者。与 "严重 "AS相比，我们仔细研究了基线 "非常严重 "AS对TAVI术后3年全因死亡或心衰住院的影响。共纳入 239 名患者（84.8 ± 5.4 岁，58 名男性）。与 "重度 "强直性脊柱炎患者相比，基线 "极重度 "强直性脊柱炎患者有65人（27%），他们表现出更晚期的肥厚和更高的B型钠尿肽水平（两者均小于0.05）。与 "重度 "AS患者相比，基线 "极重度 "AS与TAVI术后较高的主要终点自由度相关（= 0.01）。与 "重度 "AS病例相比，基线 "非常严重 "AS的存在与TAVI术后临床预后的改善存在矛盾关系。

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 cardiology CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

4.90

自引率

8.00%

发文量

202

审稿时长

29 days

期刊介绍： The official journal of the Japanese College of Cardiology is an international, English language, peer-reviewed journal publishing the latest findings in cardiovascular medicine. Journal of Cardiology (JC) aims to publish the highest-quality material covering original basic and clinical research on all aspects of cardiovascular disease. Topics covered include ischemic heart disease, cardiomyopathy, valvular heart disease, vascular disease, hypertension, arrhythmia, congenital heart disease, pharmacological and non-pharmacological treatment, new diagnostic techniques, and cardiovascular imaging. JC also publishes a selection of review articles, clinical trials, short communications, and important messages and letters to the editor.