经导管主动脉瓣置换术后早期左室舒张末期内径改善对患者预后的影响  

Influence of early left ventricular end-diastolic diameter improvement on prognosis of severe aortic valve stenosis patients after transcatheter aortic valve replacement

作　　者：胡美玲 王勇 刘婷 李春 曾颖 胡金蓉 王颖 钱德慧 于世勇 晋军 HU Meiling;WANG Yong;LIU Ting;LI Chun;ZENG Ying;HU Jinrong;WANG Ying;QIAN Dehui;YU Shiyong;JIN Jun(Department of Cardiology,Second Affiliated Hospital,Army Medical University(Third Military Medical University),Chongqing,400037,China;Ultrasound Medical Center,Second Affiliated Hospital,Army Medical University(Third Military Medical University),Chongqing,400037,China;Department of Neurology,Second Affiliated Hospital,Army Medical University(Third Military Medical University),Chongqing,400037,China)

机构地区：[1]陆军军医大学(第三军医大学)第二附属医院心血管内科,重庆400037 [2]陆军军医大学(第三军医大学)第二附属医院超声医学中心,重庆400037 [3]陆军军医大学(第三军医大学)第二附属医院神经内科,重庆400037

出　　处：《陆军军医大学学报》2023年第3期243-250,共8页Journal of Army Medical University

基　　金：重庆市医学英才计划项目(CQYC201903087)。

摘　　要：目的 探讨重度主动脉瓣狭窄(aortic valve stenosis, AS)患者经导管主动脉瓣置换术(transcatheter aortic valve replacement, TAVR)后早期左室舒张末期内径(left ventricular end-diastolic diameter, LVEDD)变化及该变化对TAVR预后的影响。方法 采用回顾性队列研究。纳入2017年12月至2021年12月在陆军军医大学第二附属医院接受TAVR治疗的重度AS患者113例。依据术后超声心动图结果将术后LVEDD较术前改善≥1.8 mm定义为早期LVEDD改善,将患者分为有改善组和无改善组。患者通过门诊或电话完成术后1年随访并收集患者心脏超声、心电图及手术相关并发症等数据。研究终点为主要不良心血管事件(major adverse cardiovascular events, MACE),包括1年的全因死亡、心肌梗死或心绞痛、心力衰竭再入院的复合终点。结果 患者年龄54~87(71.2±6.5)岁,其中女性59例(52.2%)。患者术后(平均术后4 d)LVEDD为(48.9±6.5)mm,较术前明显缩短[(50.7±7.3)mm,P<0.001];术后LVEDD早期改善患者53例(46.9%)。单因素Cox回归分析发现术前合并糖尿病(HR:2.635,95%CI:1.013~6.858,P=0.047)、术后起搏器植入(HR:3.518,95%CI:1.336~9.263,P=0.011)是1年时MACE的危险因素;而早期LVEDD改善是其保护因素(HR:0.176,95%CI:0.052~0.601,P=0.006)。多因素Cox分析发现早期LVEDD改善仍是1年时MACE的独立保护因素(HR:0.231,95%CI:0.062~0.857,P=0.029)。结论 TAVR术后早期患者LVEDD出现不同程度好转,早期出现LVEDD改善的患者1年时发生MACE的累计风险较无改善患者低。Objective To investigate the early changes of left ventricular end-diastolic diameter(LVEDD) in patients with severe aortic valve stenosis(AS) after transcatheter aortic valve replacement(TAVR) and the effect of the changes on the prognosis of TAVR. Methods A single-center retrospective cohort study was performed on 113 severe AS patients undergoing TAVR treatment in our hospital from December 2017 to December 2021. When the improvement of postoperative to preoperative LVEDD ≥1.8 mm was defined as early LVEDD improvement by echocardiography, the patients were divided into improvement group and non-improvement group. After the patients were followed up in 1 year after TAVR through clinic or telephone visits, their clinical data on cardiac ultrasound, electrocardiogram, and surgery-related complications were collected. The endpoints were major adverse cardiovascular events(MACE), including 1-year all-cause mortality, myocardial infarction or angina, and heart failure-related hospitalization. Results The average age of the patients was 71.2±6.5 years, and 59(52.2%) of them were female. The postoperative(4 d after TAVR on average) LVEDD was 48.9±6.5 mm, significantly shorter than that preoperatively(50.7±7.3 mm, P<0.001). There were 53 patients obtaining early improvement of LVEDD before discharge, accounting for 46.9% of the discharged patients. Univariate Cox regression analysis found that preoperative diabetes(HR: 2.635, 95%CI: 1.013~6.858, P=0.047) and postoperative pacemaker implantation(HR: 3.518, 95%CI: 1.336~9.263, P=0.011) were risk factors for MACE at 1 year, and early improvement of LVEDD was a protective factor(HR: 0.176, 95%CI: 0.052~0.601, P=0.006). Multivariate Cox analysis indicated that early LVEDD improvement was still an independent protective factor for MACE at 1 year(HR: 0.231, 95%CI: 0.062~0.857, P=0.029). Conclusion LVEDD can be improved to various degrees in the early stage after TAVR, and the cumulative risk of developing MACE at 1 year in patients with early improvement of LVEDD is lowe

关 键 词：主动脉瓣狭窄 经导管主动脉瓣置换术 早期左室舒张末内径 预后 

分 类 号：R445.1[医药卫生—影像医学与核医学] R543.1[医药卫生—诊断学] R654.207[医药卫生—临床医学]