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

Meiling HU; Yong WANG; Ting LIU; Chun LI; Ying ZENG; Jinrong HU; Ying WANG; Dehui QIAN; Shiyong YU; Jun JIN

doi:10.16016/j.2097-0927.202210010

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

Clinical Medicine | 更新时间：2026-01-09

- Influence of early left ventricular end-diastolic diameter improvement on prognosis of severe aortic valve stenosis patients after transcatheter aortic valve replacement
- Journal of Army Medical University Vol. 45, Issue 3, Pages: 243-250(2023)
- 作者机构：
  
  1.400037 重庆, 陆军军医大学(第三军医大学)第二附属医院心血管内科
  2.400037 重庆, 陆军军医大学(第三军医大学)第二附属医院超声医学中心
  3.400037 重庆, 陆军军医大学(第三军医大学)第二附属医院神经内科
- 作者简介：
- 基金信息：
  
  the Project of Chongqing Medical Talent Plan(CQYC201903087)
- DOI：10.16016/j.2097-0927.202210010
  CLC： R445.1;R543.1;R654.207
- Received：04 October 2022，
  
  Revised：2022-11-07，
  
  Published：15 February 2023
- 稿件说明：
移动端阅览
Meiling HU, Yong WANG, Ting LIU, et al. Influence of early left ventricular end-diastolic diameter improvement on prognosis of severe aortic valve stenosis patients after transcatheter aortic valve replacement[J]. Journal of Army Medical University, 2023, 45(3): 243-250.
DOI：

Meiling HU, Yong WANG, Ting LIU, et al. Influence of early left ventricular end-diastolic diameter improvement on prognosis of severe aortic valve stenosis patients after transcatheter aortic valve replacement[J]. Journal of Army Medical University, 2023, 45(3): 243-250. DOI： 10.16016/j.2097-0927.202210010.

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

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(

: 2.635

95%

: 1.013~6.858

=0.047)、术后起搏器植入(

: 3.518

95%

: 1.336~9.263

=0.011)是1年时MACE的危险因素; 而早期LVEDD改善是其保护因素(

: 0.176

95%

: 0.052~0.601

=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(

: 0.231

95%

: 0.062~0.857

=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。

Abstract

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 preoperati

vely (50.7±7.3 mm

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 (

: 2.635

95%

: 1.013~6.858

=0.047) and postoperative pacemaker implantation (

: 3.518

95%

: 1.336~9.263

=0.011) were risk factors for MACE at 1 year

and early improvement of LVEDD was a protective factor (

: 0.176

95%

: 0.052~0.601

=0.006).Multivariate Cox analysis indicated that early LVEDD improvement was still an independent protective factor for MACE at 1 year (

: 0.231

95%

: 0.062~0.857

=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 lower than that of patients without improvement.

关键词

Keywords

references

COFFEY S, ROBERTS-THOMSON R, BROWN A, et al . Global epidemiology of valvular heart disease[J ] . Nat Rev Cardiol, 2021, 18(12): 853-864. DOI: 10.1038/s41569-021-00570-z.

STRANGE G, STEWART S, CELERMAJER D, et al . Poor long-term survival in patients with moderate aortic stenosis[J ] . J Am Coll Cardiol, 2019, 74(15): 1851-1863. DOI: 10.1016/j.jacc.2019.08.004.

CHEITLIN M D, GERTZ E W, BRUNDAGE B H, et al . Rate of progression of severity of valvular aortic stenosis in the adult[J ] . Am Heart J, 1979, 98(6): 689-700. DOI: 10.1016/0002-8703(79)90465-4.

KAMPAKTSIS P N, KOKKINIDIS D G, WONG S C, et al . The role and clinical implications of diastolic dysfunction in aortic stenosis[J ] . Heart, 2017, 103(19): 1481-1487. DOI: 10.1136/heartjnl-2017-311506.

AZEVEDO P S, POLEGATO B F, MINICUCCI M F, et al . Cardiac remodeling: concepts, clinical impact, pathophysiological mechanisms and pharmacologic treatment[J ] . Arq Bras Cardiol, 2016, 106(1): 62-69. DOI: 10.5935/abc.20160005.

TURINA J, HESS O, SEPULCRI F, et al . Spontaneous course of aortic valve disease[J ] . Eur Heart J, 1987, 8(5): 471-483. DOI: 10.1093/oxfordjournals.eurheartj.a062307.

周达新, 潘文志, 吴永健, 等. 经导管主动脉瓣置换术中国专家共识(2020更新版)[J]. 中国介入心脏病学杂志, 2020, 28(6): 301-309. DOI: 10.3969/j.issn.1004-8812.2020.06.001.

ZHOU D X, PAN W Z, WU Y J, et al . Chinese expert consensus on transcatheter aortic valve replacement (2020 updated edition)[J ] . Chin J Interv Cardiol, 2020, 28(6): 301-309. DOI: 10.3969/j.issn.1004-8812.2020.06.001.

MACK M J, LEON M B, THOURANI V H, et al . Transcatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients[J ] . N Engl J Med, 2019, 380(18): 1695-1705. DOI: 10.1056/NEJMoa1814052.

冯晔子. 经导管主动脉瓣膜置换术对主动脉瓣重度狭窄患者左心功能及结构影响的研究[D]. 新乡: 新乡医学院, 2021.

FENG Y Z. Effects of transcatheter aortic valve replacement on left cardiac function and structure in patients with severe aortic stenosis[D]. Xinxiang: Xinxiang Medical University, 2021.

DING W H, LAM Y Y, KAYA M G, et al . Echocardiographic predictors of left ventricular functional recovery following valve replacement surgery for severe aortic stenosis[J ] . Int J Cardiol, 2008, 128(2): 178-184. DOI: 10.1016/j.ijcard.2007.05.025.

王勇, 罗小林, 张辰, 等. 经导管主动脉瓣置换术植入 Venus -A瓣膜后发生瓣周漏的危险因素分析[J ] . 中华心血管病杂志, 2021, 49 (7): 694-700. DOI: 10.3760/cma.j.cn112148-20210131-00116.

WANG Y, LUO X L, ZHANG C, et al . Risk factors of perivalvular leakage after transcatheter aortic valve replacement with Venus -A valve[J ] . Chin J Cardiol, 2021, 49 (7): 694-700. DOI: 10.3760/cma.j.cn112148-20210131-00116..

GÉNÉREUX P, PIAZZA N, ALU M C, et al . Valve academic research consortium 3: updated endpoint definitions for aortic valve clinical research[J ] . J Am Coll Cardiol, 2021, 77(21): 2717-2746. DOI: 10.1016/j.jacc.2021.02.038.

COHN J N, FERRARI R, SHARPE N. Cardiac remodeling: concepts and clinical implications: a consensus paper from an international forum on cardiac remodeling. Behalf of an International Forum on Cardiac Remodeling[J]. J Am Coll Cardiol, 2000, 35(3): 569-582. DOI: 10.1016/s0735-1097(99)00630-0.

YARBROUGH W M, MUKHERJEE R, IKONOMIDIS J S, et al . Myocardial remodeling with aortic stenosis and after aortic valve replacement: mechanisms and future prognostic implications[J ] . J Thorac Cardiovasc Surg, 2012, 143(3): 656-664. DOI: 10.1016/j.jtcvs.2011.04.044.

KONSTAM M A, KRAMER D G, PATEL A R, et al . Left ventricular remodeling in heart failure: current concepts in clinical significance and assessment[J ] . JACC Cardiovasc Imaging, 2011, 4(1): 98-108. DOI: 10.1016/j.jcmg.2010.10.008.

URIEL N, SAYER G, ANNAMALAI S, et al . Mechanical unloading in heart failure[J ] . J Am Coll Cardiol, 2018, 72(5): 569-580. DOI: 10.1016/j.jacc.2018.05.038.

REIS FILHO J R, CARDOSO J N, CARDOSO C M, et al . Reverse cardiac remodeling: a marker of better prognosis in heart failure[J ] . Arq Bras Cardiol, 2015, 104(6): 502-506. DOI: 10.5935/abc.20150025.

VAHANIAN A, BEYERSDORF F, PRAZ F, et al . 2021 ESC/EACTS Guidelines for the management of valvular heart disease[J ] . Eur Heart J, 2022, 43(7): 561-632. DOI: 10.1093/eurheartj/ehab395.

MEHDIPOOR G, CHEN S, CHATTERJEE S, et al . Cardiac structural changes after transcatheter aortic valve replacement: systematic review and meta-analysis of cardiovascular magnetic resonance studies[J ] . J Cardiovasc Magn Reson, 2020, 22(1): 41. DOI: 10.1186/s12968-020-00629-9.

PORTER C B, WALSH R A, BADKE F R, et al . Differential effects of diltiazem and nitroprusside on left ventricular function in experimental chronic volume overload[J ] . Circulation, 1983, 68(3): 685-692. DOI: 10.1161/01.cir.68.3.685.

AIMO A, GAGGIN H K, BARISON A, et al . Imaging, biomarker, and clinical predictors of cardiac remodeling in heart failure with reduced ejection fraction[J ] . JACC Heart Fail, 2019, 7(9): 782-794. DOI: 10.1016/j.jchf.2019.06.004.

KIM G H, URIEL N, BURKHOFF D. Reverse remodelling and myocardial recovery in heart failure[J]. Nat Rev Cardiol, 2018, 15(2): 83-96. DOI: 10.1038/nrcardio.2017.139.

KILICASLAN B, UNAL B, COSKUN M S, et al . Post transcatheter aortic valve replacement ejection fraction response is predictor of survival among patients with whole range of systolic dysfunction[J ] . Acta Cardiol, 2021, 76(5): 475-485. DOI: 10.1080/00015385.2020.1843853.

KLOTZ S, BARBONE A, REIKEN S, et al . Left ventricular assist device support normalizes left and right ventricular beta-adrenergic pathway properties[J ] . J Am Coll Cardiol, 2005, 45(5): 668-676. DOI: 10.1016/j.jacc.2004.11.042.

CATINO A B, FERRIN P, WEVER-PINZON J, et al . Clinical and histopathological effects of heart failure drug therapy in advanced heart failure patients on chronic mechanical circulatory support[J ] . Eur J Heart Fail, 2018, 20(1): 164-174. DOI: 10.1002/ejhf.1018.

RODRIGUEZ-GABELLA T, CATALÁ P, MUÑOZ-GARCÍA A J, et al . Renin-angiotensin system inhibition following transcatheter aortic valve replacement[J ] . J Am Coll Cardiol, 2019, 74(5): 631-641. DOI: 10.1016/j.jacc.2019.05.055.

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