接受 TAVI 手术的低流量低梯度主动脉瓣狭窄且射血分数保留的患者心房颤动与存活率的关系。

IF 4.8 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

European Heart Journal - Quality of Care and Clinical Outcomes Pub Date : 2024-05-22 DOI:10.1093/ehjqcco/qcad045

Masaaki Nakase, Daijiro Tomii, Dik Heg, Fabien Praz, Stefan Stortecky, Jonas Lanz, David Reineke, Stephan Windecker, Thomas Pilgrim

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引用次数: 0

摘要

目的：关于低流量、低梯度主动脉瓣狭窄伴射血分数保留（LFLG-pEF AS）患者心房颤动（AF）的预后意义，目前证据有限。我们的目的是评估经导管主动脉瓣植入术（TAVI）后搏出量的恢复情况，以及根据房颤存在与否对低流量低梯度主动脉瓣狭窄伴射血分数保留（LFLG-pEF AS）患者的临床预后进行分层：在一项前瞻性TAVI登记中，根据血流梯度状态和是否存在房颤对左室射血分数保留（LVEF≥50%）的患者进行了分层。在2007年8月至2021年6月期间，2259名左室射血分数保留的TAVI患者中，765人患有高梯度AS（HG AS），444人患有LFLG-pEF AS。在199名HG AS患者（26.0%）和190名LFLG-pEF AS患者（42.8%）中观察到房颤。1 年后，无房颤的 LFLG-pEF AS 患者卒中容量指数（SVi）明显改善，而有房颤的患者 SVi 仍较低（分别从 25.9 ± 8.5 mL/m2 到 37.2 ± 9.9 mL/m2 和从 26.8 ± 5.1 mL/m2 到 26.1 ± 9.1 mL/m2）。与无房颤的患者相比，LFLG-pEF AS 患者的 1 年全因死亡风险增加（调整后危险比 (HRadjusted) 2.57；95% 置信区间 [CI] 1.44-4.59）。无房颤的LFLG-pEF AS患者与无房颤的HG AS患者的死亡率相似（调整后危险比为0.85；95% CI为0.49-1.46）：临床试验注册：https://www.clinicaltrials.gov。NCT01368250。

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Association of atrial fibrillation with survival in patients with low-flow low-gradient aortic stenosis with preserved ejection fraction undergoing TAVI.

Aims: There is limited evidence on the prognostic significance of atrial fibrillation (AF) in patients with low flow, low-gradient aortic stenosis with preserved ejection fraction (LFLG-pEF AS). We aimed to evaluate the recovery of stroke volume after transcatheter aortic valve implantation (TAVI) and clinical outcomes in patients with LFLG-pEF AS stratified by presence or absence of AF.

Methods and results: In a prospective TAVI registry, patients with preserved left ventricular ejection fraction (LVEF ≥ 50%) were stratified according to flow-gradient status and presence of AF. Among 2259 TAVI patients with preserved LVEF between August 2007 and June 2021, 765 had high-gradient AS (HG AS) and 444 had LFLG-pEF AS. AF was observed in 199 patients with HG AS (26.0%) and 190 patients with LFLG-pEF AS (42.8%). At 1 year, stroke volume index (SVi) was significantly improved in LFLG-pEF AS patients without AF, while SVi remained low in patients with AF (from 25.9 ± 8.5 mL/m2 to 37.2 ± 9.9 mL/m2 and from 26.8 ± 5.1 mL/m2 to 26.1 ± 9.1 mL/m2, respectively). LFLG-pEF AS patients with AF had an increased risk of 1-year all-cause mortality compared with those without AF (adjusted hazard ratio (HRadjusted) 2.57; 95% confidence interval [CI] 1.44-4.59). LFLG-pEF AS patients without AF had similar mortality compared with HG AS patients without AF (HRadjusted 0.85; 95% CI 0.49-1.46).

Conclusion: Patients with LFLG-pEF AS and AF experienced no relevant recovery of stroke volume after TAVI, but a more than two-fold increased risk of death compared to patients with HG AS or LFLG-pEF AS without AF.

Clinical trial registration: https://www.clinicaltrials.gov. NCT01368250.

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来源期刊

European Heart Journal - Quality of Care and Clinical Outcomes CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

9.40

自引率

3.80%

发文量

期刊介绍： European Heart Journal - Quality of Care & Clinical Outcomes is an English language, peer-reviewed journal dedicated to publishing cardiovascular outcomes research. It serves as an official journal of the European Society of Cardiology and maintains a close alliance with the European Heart Health Institute. The journal disseminates original research and topical reviews contributed by health scientists globally, with a focus on the quality of care and its impact on cardiovascular outcomes at the hospital, national, and international levels. It provides a platform for presenting the most outstanding cardiovascular outcomes research to influence cardiovascular public health policy on a global scale. Additionally, the journal aims to motivate young investigators and foster the growth of the outcomes research community.