Jorge Nuche , Julien Ternacle , Marisa Avvedimento , Asim N. Cheema , Gabriela Veiga-Fernández , Antonio J. Muñoz-García , Victoria Vilalta , Ander Regueiro , Luis Asmarats , María del Trigo , Vicenç Serra , Guillaume Bonnet , Melchior Jonveaux , Giovanni Esposito , Effat Rezaei , José M. de la Torre-Hernández , Eduard Fernández-Nofrerías , Pablo Vidal , Lola Gutiérrez-Alonso , Juan Francisco Oteo , Josep Rodés-Cabau
{"title":"经导管主动脉瓣植入术后功能等级下降的发生率、预测因素和预后影响","authors":"Jorge Nuche , Julien Ternacle , Marisa Avvedimento , Asim N. Cheema , Gabriela Veiga-Fernández , Antonio J. Muñoz-García , Victoria Vilalta , Ander Regueiro , Luis Asmarats , María del Trigo , Vicenç Serra , Guillaume Bonnet , Melchior Jonveaux , Giovanni Esposito , Effat Rezaei , José M. de la Torre-Hernández , Eduard Fernández-Nofrerías , Pablo Vidal , Lola Gutiérrez-Alonso , Juan Francisco Oteo , Josep Rodés-Cabau","doi":"10.1016/j.recesp.2023.11.002","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction and objectives</h3><p>There are scarce data on the factors associated with impaired functional status after transcatheter aortic valve replacement (TAVR) and its clinical impact. This study aimed to determine the incidence, predictors, and prognostic implications of impaired functional class (NYHA class III-IV) following TAVR.</p></div><div><h3>Methods</h3><p>This multicenter study included 3462 transarterial TAVR patients receiving newer generation devices. The patients were compared according to their NYHA class at 1 month of follow-up (NYHA I-II vs NYHA III-IV). A multivariate logistic regression was performed to identify the predictors of 30-day NYHA class III-IV. Patient survival was compared with the Kaplan-Meier method and factors associated with decreased survival were identified with Cox regression analysis.</p></div><div><h3>Results</h3><p>The mean age of the study population was 80.3<!--> <!-->±<!--> <!-->7.3 years, with 47% of women, and a median Society of Thoracic Surgeons score of 3.8% [IQR, 2.5-5.8]. A total of 208 patients (6%) were in NYHA class III-IV 1 month after TAVR. Predictors of 30-day NYHA class III-IV were baseline NYHA class III-IV (OR, 1.76; 95%CI, 1.08-2.89; <em>P</em> <!-->=<!--> <!-->.02), chronic pulmonary obstructive disease (OR, 1.80; 95%CI, 1.13-2.83; <em>P</em> <!-->=<!--> <!-->.01), and post-TAVR severe mitral regurgitation (OR, 2.00; 95%CI, 1.21-3.31; <em>P</em> <!--><<!--> <!-->.01). Patients in NYHA class III-IV 1 month after TAVR were at higher risk of death (HR, 3.68; 95%CI, 2.39-5.70; <em>P</em> <!--><<!--> <!-->.01) and heart failure-related hospitalization (HR, 6.00; 95%CI, 3.76-9.60; <em>P</em> <!--><<!--> <!-->.01) at 1-year follow-up.</p></div><div><h3>Conclusions</h3><p>Up to 6% of contemporary TAVR patients exhibited an impaired functional status following TAVR. Worse baseline NYHA class, chronic pulmonary obstructive disease, and severe mitral regurgitation predicted 30-day NYHA class III/IV, and this determined a higher risk of mortality and heart failure hospitalization at 1-year follow-up. Further studies on the prevention and treatment optimization of patients with impaired functional status after TAVR are needed.</p></div>","PeriodicalId":21299,"journal":{"name":"Revista espanola de cardiologia","volume":null,"pages":null},"PeriodicalIF":5.9000,"publicationDate":"2024-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Incidencia, predictores e impacto pronóstico de una clase funcional disminuida inmediatamente después de un implante percutáneo de válvula aórtica\",\"authors\":\"Jorge Nuche , Julien Ternacle , Marisa Avvedimento , Asim N. Cheema , Gabriela Veiga-Fernández , Antonio J. Muñoz-García , Victoria Vilalta , Ander Regueiro , Luis Asmarats , María del Trigo , Vicenç Serra , Guillaume Bonnet , Melchior Jonveaux , Giovanni Esposito , Effat Rezaei , José M. de la Torre-Hernández , Eduard Fernández-Nofrerías , Pablo Vidal , Lola Gutiérrez-Alonso , Juan Francisco Oteo , Josep Rodés-Cabau\",\"doi\":\"10.1016/j.recesp.2023.11.002\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Introduction and objectives</h3><p>There are scarce data on the factors associated with impaired functional status after transcatheter aortic valve replacement (TAVR) and its clinical impact. This study aimed to determine the incidence, predictors, and prognostic implications of impaired functional class (NYHA class III-IV) following TAVR.</p></div><div><h3>Methods</h3><p>This multicenter study included 3462 transarterial TAVR patients receiving newer generation devices. The patients were compared according to their NYHA class at 1 month of follow-up (NYHA I-II vs NYHA III-IV). A multivariate logistic regression was performed to identify the predictors of 30-day NYHA class III-IV. Patient survival was compared with the Kaplan-Meier method and factors associated with decreased survival were identified with Cox regression analysis.</p></div><div><h3>Results</h3><p>The mean age of the study population was 80.3<!--> <!-->±<!--> <!-->7.3 years, with 47% of women, and a median Society of Thoracic Surgeons score of 3.8% [IQR, 2.5-5.8]. A total of 208 patients (6%) were in NYHA class III-IV 1 month after TAVR. Predictors of 30-day NYHA class III-IV were baseline NYHA class III-IV (OR, 1.76; 95%CI, 1.08-2.89; <em>P</em> <!-->=<!--> <!-->.02), chronic pulmonary obstructive disease (OR, 1.80; 95%CI, 1.13-2.83; <em>P</em> <!-->=<!--> <!-->.01), and post-TAVR severe mitral regurgitation (OR, 2.00; 95%CI, 1.21-3.31; <em>P</em> <!--><<!--> <!-->.01). Patients in NYHA class III-IV 1 month after TAVR were at higher risk of death (HR, 3.68; 95%CI, 2.39-5.70; <em>P</em> <!--><<!--> <!-->.01) and heart failure-related hospitalization (HR, 6.00; 95%CI, 3.76-9.60; <em>P</em> <!--><<!--> <!-->.01) at 1-year follow-up.</p></div><div><h3>Conclusions</h3><p>Up to 6% of contemporary TAVR patients exhibited an impaired functional status following TAVR. Worse baseline NYHA class, chronic pulmonary obstructive disease, and severe mitral regurgitation predicted 30-day NYHA class III/IV, and this determined a higher risk of mortality and heart failure hospitalization at 1-year follow-up. Further studies on the prevention and treatment optimization of patients with impaired functional status after TAVR are needed.</p></div>\",\"PeriodicalId\":21299,\"journal\":{\"name\":\"Revista espanola de cardiologia\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":5.9000,\"publicationDate\":\"2024-03-07\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Revista espanola de cardiologia\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0300893223004827\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Revista espanola de cardiologia","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0300893223004827","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"Medicine","Score":null,"Total":0}
Incidencia, predictores e impacto pronóstico de una clase funcional disminuida inmediatamente después de un implante percutáneo de válvula aórtica
Introduction and objectives
There are scarce data on the factors associated with impaired functional status after transcatheter aortic valve replacement (TAVR) and its clinical impact. This study aimed to determine the incidence, predictors, and prognostic implications of impaired functional class (NYHA class III-IV) following TAVR.
Methods
This multicenter study included 3462 transarterial TAVR patients receiving newer generation devices. The patients were compared according to their NYHA class at 1 month of follow-up (NYHA I-II vs NYHA III-IV). A multivariate logistic regression was performed to identify the predictors of 30-day NYHA class III-IV. Patient survival was compared with the Kaplan-Meier method and factors associated with decreased survival were identified with Cox regression analysis.
Results
The mean age of the study population was 80.3 ± 7.3 years, with 47% of women, and a median Society of Thoracic Surgeons score of 3.8% [IQR, 2.5-5.8]. A total of 208 patients (6%) were in NYHA class III-IV 1 month after TAVR. Predictors of 30-day NYHA class III-IV were baseline NYHA class III-IV (OR, 1.76; 95%CI, 1.08-2.89; P = .02), chronic pulmonary obstructive disease (OR, 1.80; 95%CI, 1.13-2.83; P = .01), and post-TAVR severe mitral regurgitation (OR, 2.00; 95%CI, 1.21-3.31; P < .01). Patients in NYHA class III-IV 1 month after TAVR were at higher risk of death (HR, 3.68; 95%CI, 2.39-5.70; P < .01) and heart failure-related hospitalization (HR, 6.00; 95%CI, 3.76-9.60; P < .01) at 1-year follow-up.
Conclusions
Up to 6% of contemporary TAVR patients exhibited an impaired functional status following TAVR. Worse baseline NYHA class, chronic pulmonary obstructive disease, and severe mitral regurgitation predicted 30-day NYHA class III/IV, and this determined a higher risk of mortality and heart failure hospitalization at 1-year follow-up. Further studies on the prevention and treatment optimization of patients with impaired functional status after TAVR are needed.
期刊介绍：
Revista Española de Cardiología, Revista bilingüe científica internacional, dedicada a las enfermedades cardiovasculares, es la publicación oficial de la Sociedad Española de Cardiología.
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