主动脉瓣狭窄与混合性主动脉瓣疾病患者经导管主动脉瓣置换术后左心室逆重构及预后的比较研究  

Comparison of left ventricular reverse remodeling and prognosis after transcatheter aortic valve replacement in aortic stenosis and mixed aortic valve disease

作　　者：孙猛 陈璐琳 白景云 严丽洁 刘静静 范宪伟 李雪洁 胡娟 吴金涛 杨海涛 SUN Meng;CHEN Lu-lin;BAI Jing-yun;YAN Li-jie;LIU Jing-jing;FAN Xian-wei;LI Xue-jie;HU Juan;WU Jin-tao;YANG Hai-tao(Department of Cardiology,Fuwai Central China Cardiovascular Hospital,Central China Fuwai Hospital of Zhengzhou University,Zhengzhou 451464,China)

机构地区：[1]阜外华中心血管病医院郑州大学华中阜外医院心内科,河南郑州451464

出　　处：《中国介入心脏病学杂志》2025年第2期71-78,共8页Chinese Journal of Interventional Cardiology

基　　金：河南省医学科技攻关计划项目(LHGJ20190784)。

摘　　要：目的 本研究旨在评估经导管主动脉瓣置换术(TAVR)对混合性主动脉瓣疾病(MAVD)和主动脉瓣狭窄(AS)患者左心室逆重构(LVRR)和预后的影响。方法 连续收集2020年1月至2022年12月于阜外华中心血管病医院行TAVR的患者149例(AS组79例,MAVD组70例)。1﹕1倾向性评分匹配用于控制患者选择偏倚。经胸超声心动图用于监测左心室射血分数及其他结构参数。研究终点为心血管死亡和心血管相关再住院的复合终点。线性混合效应模型和Logistic回归分别用于比较两组间超声心动图的动态变化和识别LVRR的相关危险因素。结果 1﹕1倾向性评分匹配后,共纳入126例患者。MAVD组TAVR术前存在更大的结构参数[左心室收缩/舒张末期内径/容积、左心室质量指数(LVMI)]和更低的左心室射血分数(LVEF)(均P<0.05),但在随访中观察到更为显著的左心室结构和血流动力学改善。多变量Logistic回归分析显示,LVMI是TAVR术后LVRR的独立预测因素(OR 1.016,95%CI 1.001~1.030),而术后仍持续存在的中度及以上二尖瓣反流(OR 0.187,95%CI0.047~0.749)和瓣周漏(OR 0.313,95%CI 0.107~0.917)则显著降低LVRR的发生率。在23个月的中位随访期间,共发生31例终点事件,经倾向性评分匹配后,两组间的长期预后差异无统计学意义(Logrank P=0.330)。结论 与AS组患者相比,MAVD组患者在TAVR术前存在更严重的左心室重构,但术后随访中观察到更显著的LVRR。此外,两组患者在TAVR术后的长期预后差异无统计学意义。Objective To evaluate the effects of transcatheter aortic valve replacement(TAVR)on left ventricular reverse remodeling(LVRR)and outcomes in patients with mixed aortic valve disease(MAVD)and predominant aortic stenosis(AS).Methods Patients undergoing TAVR at our center between January 2020 and December 2022 were enrolled consecutively.Propensity score matching(PSM)(1﹕1 ratio)was used to reduce selection bias.Transthoracic echocardiography(TTE)was used to monitor left ventricular ejection fraction(LVEF)and other structural parameters over time.The study outcome was a composite of cardiovascular death and rehospitalization due to cardiovascular causes.Linear mixed-effects models and logistic regression were utilized for comparing echocardiographic changes across groups and identifying independent risk factors for no-LVRR,respectively.Results After PSM,126 patients were included.MAVD group exhibited larger structural parameters(left ventricular end-systolic/end-diastolic diameter and volume,left ventricular mass index)and a lower left ventricular ejection fraction(LVEF)(all P<0.05).However,more pronounced improvements in left ventricular structure and hemodynamics were observed during follow-up.Multivariate logistic regression analysis indicated that the left ventricular mass index(LVMI)was an independent predictor of left ventricular reverse remodeling(LVRR)after TAVR,whereas persistent moderate or greater mitral regurgitation(MR)and paravalvular leak(PVL)significantly reduced the incidence of LVRR.During a median follow-up period of 23 months,a total of 31 endpoint events occurred,and there was no statistically significant difference in long-term prognosis between the two groups(Log-rank P=0.330).Conclusions Compared to patients in the AS group,those in the MAVD group exhibited more severe left ventricular remodeling before TAVR.However,more significant LVRR was observed during postoperative follow-up.Additionally,the long-term prognosis was comparable between the two groups.

关 键 词：左心室逆重构 混合性主动脉瓣疾病 主动脉瓣狭窄 经导管主动脉瓣置换术 

分 类 号：R54[医药卫生—心血管疾病]