Changes of Right Ventricular Function After Transcatheter Aortic Valve Replacement and Association With Outcomes
Changes of Right Ventricular Function After Transcatheter Aortic Valve Replacement and Association With Outcomes
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DOI：
10.1016/j.cardfail.2021.03.007
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发表时间：
2021-12-01
影响因子：
6
通讯作者：
Ledwoch, Jakob
中科院分区：
文献类型：
--
作者：
Poch, Felix;Thalmann, Ruth;Ledwoch, Jakob
背景：基线右心室（RV）功能障碍是经导管主动脉瓣置换术（TAVR）患者预后不良的预测指标。然而，TAVR后右心室功能可能改善，这可能对预后有重要影响。本研究的目的是评估TAVR后右心室功能的变化及其对临床结果的预后价值。方法与结果：根据超声心动图随访6个月时右室功能的变化，将我院行TAVR的患者连续入组分为4组。共纳入188例患者。那些在基线时功能正常的人。87%（130/149）的患者在随访中保留了右心室功能（组1），而13%（19/149）的患者出现了新的右心室功能障碍（组2）。在基线时有右心室功能障碍的患者（39例）中，46%(18/39)（第3组）右心室功能恢复正常，54%(21/39)（第4组）右心室功能受损。Kaplan-Meier估计3年生存率在组1患者中最高（83%），在组2患者中居中（65%），组3患者中居中（69%），而组4患者的生存率最差（37%;P < 0.001）。此外，在随访期间，新的或持续的右心室功能障碍被确定为与死亡率独立相关（风险比2.55：四分位数范围1.03-6.47,P = 0.004）。结论：保留左心室功能的患者有较高的3年生存率。与持续右心室功能障碍的患者相比，右心室功能正常化的患者生存率提高，后者尽管进行了TAVR，但预后不佳。
Background: Baseline right ventricular (RV) dysfunction represents a predictor for poor outcome in patients undergoing transcatheter aortic valve replacement (TAVR). flowever, RV function may improve after TAVR, which could have important implications on outcomes. The aim of the present study was to assess changes in RV function after TAVR and its prognostic value regarding clinical outcome.Methods and Results: Patients undergoing TAVR at our institution were consecutively enrolled and categorized into 4 groups according to changes in RV function during echocardiographic follow-up at 6 months. A total of 188 patients were included. Of those showing normal function at baseline. 87% (130/149) had preserved RV function at follow-up (group 1), whereas 13% (19/149) developed new RV dysfunction (group 2). Of those with RV dysfunction at baseline (39 patients), RV function normalized in 46% (18/39) (group 3) and remained impaired in 54% (21/39) (group 4). The Kaplan-Meier estimated survival at 3 years was highest in patients in group 1 (83%), intermediate in group 2 (65%) and 3 (69%), whereas group 4 had the worst survival (37%; P < .001). Furthermore, new or persistent RV dysfunction was identified to be independently associated with mortality during follow-up (hazard ratio 2.55: interquartile range 1.03-6.47, P = .004).Conclusions: Patients with preserved RV function have a high 3-year survival. Normalization of RV function showed improved survival compared with patients with persistent RV dysfunction, who had a dismal prognosis despite TAVR.