{"title":"超声心动图评价心脏损伤评分预测经导管主动脉瓣置入术严重主动脉瓣狭窄患者的预后:LAPLACE-TAVI登记分析","authors":"Shunsuke Edamura, Harutoshi Tamura, Tetsu Watanabe, Takayuki Sugai, Masahiro Wanezaki, Satoshi Nishiyama, Ryosuke Higuchi, Kenichi Hagiya, Itaru Takamisawa, Mamoru Nanasato, Nobuo Iguchi, Morimasa Takayama, Jun Shimizu, Shinichiro Doi, Shinya Okazaki, Masaki Ishiyama, Hiroaki Yokoyama, Shuichiro Takanashi, Motoki Fukutomi, Mike Saji, Masafumi Watanabe","doi":"10.1007/s00380-025-02569-9","DOIUrl":null,"url":null,"abstract":"<p><p>Transcatheter aortic valve implantation (TAVI) has become available for elderly patients with aortic stenosis (AS). However, no markers have been established to predict prognosis after TAVI. Cardiac damage caused by AS progresses sequentially in most cases through the left ventricle, left atrium, and right ventricle. However, cardiac damage does not always progress sequentially. This study examined whether the burden of cardiac damage assessed by echocardiography predicts prognosis in patients with severe AS who underwent TAVI. We assessed patient data from a multicenter TAVI registry involving seven hospitals in Japan. Among 1,850 patients with severe AS, patients with preserved LV ejection fraction were included. We performed echocardiography before TAVI in 1,285 patients. The primary endpoint was cardiovascular (CV) events including CV deaths and rehospitalizations for heart failure. During a median follow-up of 741 days, 76 CV events occurred. A multivariate Cox-proportional hazards analysis revealed that four echocardiographic parameters, including tricuspid regurgitation pressure gradient, E/e', left atrial volume index, and left ventricular mass index were associated with CV events. We created a scoring system using these four echocardiographic parameters. The echocardiography-directed aortic stenosis score (EDA score) was computed by assigning one point each for the presence of abnormal parameters. The receiver operating characteristic curve of EDA score for CV events showed an area under the curve value of 0.74, a cutoff value of 3 points, a sensitivity value of 75%, and a specificity value of 63%. Kaplan-Meier analysis showed that CV event rates were significantly higher in patients with high EDA scores compared with those having low scores. Hazard ratio was 14.3-fold for the 3-point group and 26.6-fold for the 4-point group when compared with the 0-point group of patients. EDA score may be a feasible indicator for risk stratification in patients with severe AS who underwent TAVI.</p>","PeriodicalId":12940,"journal":{"name":"Heart and Vessels","volume":" ","pages":""},"PeriodicalIF":1.5000,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Scoring of cardiac damage evaluated by echocardiography predicts prognosis of patients with severe aortic stenosis undergoing transcatheter aortic valve implantation: analysis of the LAPLACE-TAVI registry.\",\"authors\":\"Shunsuke Edamura, Harutoshi Tamura, Tetsu Watanabe, Takayuki Sugai, Masahiro Wanezaki, Satoshi Nishiyama, Ryosuke Higuchi, Kenichi Hagiya, Itaru Takamisawa, Mamoru Nanasato, Nobuo Iguchi, Morimasa Takayama, Jun Shimizu, Shinichiro Doi, Shinya Okazaki, Masaki Ishiyama, Hiroaki Yokoyama, Shuichiro Takanashi, Motoki Fukutomi, Mike Saji, Masafumi Watanabe\",\"doi\":\"10.1007/s00380-025-02569-9\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p>Transcatheter aortic valve implantation (TAVI) has become available for elderly patients with aortic stenosis (AS). However, no markers have been established to predict prognosis after TAVI. Cardiac damage caused by AS progresses sequentially in most cases through the left ventricle, left atrium, and right ventricle. However, cardiac damage does not always progress sequentially. This study examined whether the burden of cardiac damage assessed by echocardiography predicts prognosis in patients with severe AS who underwent TAVI. We assessed patient data from a multicenter TAVI registry involving seven hospitals in Japan. Among 1,850 patients with severe AS, patients with preserved LV ejection fraction were included. We performed echocardiography before TAVI in 1,285 patients. The primary endpoint was cardiovascular (CV) events including CV deaths and rehospitalizations for heart failure. During a median follow-up of 741 days, 76 CV events occurred. A multivariate Cox-proportional hazards analysis revealed that four echocardiographic parameters, including tricuspid regurgitation pressure gradient, E/e', left atrial volume index, and left ventricular mass index were associated with CV events. We created a scoring system using these four echocardiographic parameters. The echocardiography-directed aortic stenosis score (EDA score) was computed by assigning one point each for the presence of abnormal parameters. The receiver operating characteristic curve of EDA score for CV events showed an area under the curve value of 0.74, a cutoff value of 3 points, a sensitivity value of 75%, and a specificity value of 63%. Kaplan-Meier analysis showed that CV event rates were significantly higher in patients with high EDA scores compared with those having low scores. Hazard ratio was 14.3-fold for the 3-point group and 26.6-fold for the 4-point group when compared with the 0-point group of patients. EDA score may be a feasible indicator for risk stratification in patients with severe AS who underwent TAVI.</p>\",\"PeriodicalId\":12940,\"journal\":{\"name\":\"Heart and Vessels\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":1.5000,\"publicationDate\":\"2025-07-11\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Heart and Vessels\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s00380-025-02569-9\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Heart and Vessels","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s00380-025-02569-9","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
Scoring of cardiac damage evaluated by echocardiography predicts prognosis of patients with severe aortic stenosis undergoing transcatheter aortic valve implantation: analysis of the LAPLACE-TAVI registry.
Transcatheter aortic valve implantation (TAVI) has become available for elderly patients with aortic stenosis (AS). However, no markers have been established to predict prognosis after TAVI. Cardiac damage caused by AS progresses sequentially in most cases through the left ventricle, left atrium, and right ventricle. However, cardiac damage does not always progress sequentially. This study examined whether the burden of cardiac damage assessed by echocardiography predicts prognosis in patients with severe AS who underwent TAVI. We assessed patient data from a multicenter TAVI registry involving seven hospitals in Japan. Among 1,850 patients with severe AS, patients with preserved LV ejection fraction were included. We performed echocardiography before TAVI in 1,285 patients. The primary endpoint was cardiovascular (CV) events including CV deaths and rehospitalizations for heart failure. During a median follow-up of 741 days, 76 CV events occurred. A multivariate Cox-proportional hazards analysis revealed that four echocardiographic parameters, including tricuspid regurgitation pressure gradient, E/e', left atrial volume index, and left ventricular mass index were associated with CV events. We created a scoring system using these four echocardiographic parameters. The echocardiography-directed aortic stenosis score (EDA score) was computed by assigning one point each for the presence of abnormal parameters. The receiver operating characteristic curve of EDA score for CV events showed an area under the curve value of 0.74, a cutoff value of 3 points, a sensitivity value of 75%, and a specificity value of 63%. Kaplan-Meier analysis showed that CV event rates were significantly higher in patients with high EDA scores compared with those having low scores. Hazard ratio was 14.3-fold for the 3-point group and 26.6-fold for the 4-point group when compared with the 0-point group of patients. EDA score may be a feasible indicator for risk stratification in patients with severe AS who underwent TAVI.
期刊介绍:
Heart and Vessels is an English-language journal that provides a forum of original ideas, excellent methods, and fascinating techniques on cardiovascular disease fields. All papers submitted for publication are evaluated only with regard to scientific quality and relevance to the heart and vessels. Contributions from those engaged in practical medicine, as well as from those involved in basic research, are welcomed.