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

IF 1.5 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS
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
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引用次数: 0

摘要

经导管主动脉瓣植入术(TAVI)已成为治疗老年主动脉瓣狭窄(AS)的有效方法。然而,目前还没有建立任何标志物来预测TAVI后的预后。AS引起的心脏损伤多数通过左心室、左心房和右心室依次进展。然而,心脏损伤并不总是顺序发展的。本研究探讨了超声心动图评估的心脏损伤负担是否能预测重度AS患者接受TAVI的预后。我们评估了来自日本7家医院的多中心TAVI登记处的患者数据。在1850例严重AS患者中,包括左室射血分数保留的患者。我们对1285例TAVI患者进行了超声心动图检查。主要终点是心血管(CV)事件,包括CV死亡和因心力衰竭再住院。在中位741天的随访期间,发生了76例CV事件。一项多变量cox -比例风险分析显示,四项超声心动图参数,包括三尖瓣反流压力梯度、E/ E′、左心房容积指数和左心室质量指数与CV事件相关。我们用这四个超声心动图参数创建了一个评分系统。超声心动图指示主动脉瓣狭窄评分(EDA评分)通过为存在异常参数分配一分来计算。CV事件EDA评分的受试者工作特征曲线曲线下面积为0.74,截断值为3点,敏感性值为75%,特异性值为63%。Kaplan-Meier分析显示,EDA得分高的患者的CV事件发生率明显高于得分低的患者。与0分组患者相比,3分组的风险比为14.3倍,4分组的风险比为26.6倍。EDA评分可能是重度AS患者接受TAVI后进行风险分层的可行指标。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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.

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来源期刊
Heart and Vessels
Heart and Vessels 医学-外周血管病
CiteScore
3.10
自引率
13.30%
发文量
211
审稿时长
2 months
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.
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