TAVR对重度主动脉瓣狭窄患者心电重构的改善作用  

The improvement effects of TAVR on cardiac electrical remodeling of patients with severe aortic stenosis

作　　者：王裕星 杨松 于铭 刘珍竹[1] 梅佳杰 曲鹏[1] Wang Yuxing;Yang Song;Yu Ming;Liu Zhenzhu;Mei Jiajie;Qu Peng(Cardiology Department,Second Affiliated Hospital of Dalian Medical University,Dalian 116021,China)

机构地区：[1]大连医科大学附属第二医院心内科,大连116021

出　　处：《中华心血管病杂志》2025年第1期56-60,共5页Chinese Journal of Cardiology

基　　金：国家自然科学基金(81670406)。

摘　　要：目的探讨经皮主动脉瓣置换术(TAVR)对重度主动脉瓣狭窄患者心电重构的改善作用及其影响因素。方法本研究为队列研究。收集2018年6月至2023年3月就诊于大连医科大学附属第二医院, 明确诊断为重度主动脉瓣狭窄且成功实施TAVR的患者的资料, 包括术前、术后1周、术后3个月的标准15导联心电图、超声心动图等, 测量并计算心电图侧壁导联的平均ST段压低程度、T波振幅。观察心电图指标的变化, 采用Spearman相关性分析探讨心电图各指标与超声心动图各指标的相关性, 采用多元线性回归分析探讨TAVR术后重度主动脉瓣狭窄患者心电重构改善的影响因素。结果共纳入33例重度主动脉瓣狭窄患者, 年龄为(73±9)岁, 其中男性15例(45%)。心电图ST段压低程度、主动脉瓣上血流速度、峰值跨主动脉瓣压力、平均跨主动脉瓣压力在术后1周即得到明显改善(P均<0.05);心电图T波低平或倒置、左心室质量、左心室质量指数的显著改善发生于TAVR术后3个月(P均<0.05)。Spearman相关性分析结果显示, ST段压低程度与主动脉瓣上血流速度、峰值跨主动脉瓣压力、平均跨主动脉瓣压力相关(P均<0.05);T波振幅与左心室质量、左心室质量指数、左心室舒张末内径、左心室射血分数相关(P均<0.05)。多元线性回归分析结果显示, 主动脉瓣上血流速度是ST段压低水平的独立影响因素(β=-0.156, P=0.007), 左心室质量指数是T波振幅的独立影响因素(β=-2.007, P=0.001)。结论重度主动脉瓣狭窄患者TAVR术后心电重构得到改善, 可能与主动脉瓣开放后心脏灌注的改善及左心室肥厚的消退有关。Objectives:To assess the effectiveness of transcatheter aortic valve replacement (TAVR) on electrocardiographic remodeling in patients with severe aortic stenosis (AS), and identify its influencing factors.Methods:A cohort study was conducted on patients with a confirmed diagnosis of severe AS who successfully underwent TAVR at the Second Affiliated Hospital of Dalian Medical University between June 2018 and March 2023. Data, including standard 15-lead electrocardiograms and echocardiograms, were collected before the operation, 1 week after the operation, and 3 months after the operation. The average degree of ST-segment depression in the lateral wall leads of the electrocardiograms, and the amplitude of the T-wave were measured and calculated. The changes of electrocardiograms indexes were observed, and Spearman correlation analysis was used to explore the correlation between each index of electrocardiograms and each index of echocardiography. Multiple linear regression analysis was used to determine the influencing factors of the improvement of electrocardiographic remodeling in patients with severe AS after TAVR.Results:A total of 33 patients with severe AS, aged (73±9) years, were included in the study. Among them there were 15 (45%) males. The degree of ST-segment depression, supra-aortic flow velocity, peak transaortic pressure, and mean transaortic pressure exhibited significant improvement at 1 week post-TAVR (all P<0.05). Similarly, significant improvements in T-wave hypoplasia or inversion, left ventricular mass, and left ventricular mass index were observed at 3 months post-TAVR (all P<0.05). The degree of ST-segment depression was found to be correlated with supra-aortic flow velocity, peak transaortic pressure, and mean transaortic pressure (all P<0.05). Additionally, a correlation was observed between T-wave amplitude and left ventricular mass, left ventricular mass index, left ventricular end-diastolic internal diameter, and left ventricular ejection fraction (all P<0.05). Multiple linear regressi

关 键 词：主动脉瓣狭窄 经皮主动脉瓣置换术 心电重构 

分 类 号：R65[医药卫生—外科学]