The usefulness of C-reactive protein to predict improving left ventricular function after aortic valve replacement in patients with aortic regurgitation
The usefulness of C-reactive protein to predict improving left ventricular function after aortic valve replacement in patients with aortic regurgitation
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DOI：
10.1016/j.ahjo.2022.100169
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发表时间：
2022-05
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通讯作者：
H. Usuku;F. Oike;E. Yamamoto;N. Kai;Koichi Egashira;T. Komorita;Kyoko Hirakawa;Shozo Kaneko;Noriaki Tabata;M. Ishii;Kenshi Yamanaga;K. Fujisue;S. Hanatani;Tadashi Hoshiyama;Hisanori Kanazawa;D. Sueta;Y. Arima;S. Takashio;H. Kawano;K. Matsushita;T. Fukui;Hirotaka Matsui;K. Tsujita
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作者：
H. Usuku;F. Oike;E. Yamamoto;N. Kai;Koichi Egashira;T. Komorita;Kyoko Hirakawa;Shozo Kaneko;Noriaki Tabata;M. Ishii;Kenshi Yamanaga;K. Fujisue;S. Hanatani;Tadashi Hoshiyama;Hisanori Kanazawa;D. Sueta;Y. Arima;S. Takashio;H. Kawano;K. Matsushita;T. Fukui;Hirotaka Matsui;K. Tsujita
背景我们的目的是阐明主动脉瓣反流 (AR) 患者主动脉瓣置换术 (AVR) 后左心室 (LV) 功能的预测因素。方法和结果在 2015 年 1 月至 2020 年 12 月在我们机构接受 AVR 的 555 例患者中，我们纳入了 44 例仅进行 AVR（或 AVR + 主动脉置换术）的患者。我们根据以下任何标准定义左室功能障碍：左室射血分数 (LVEF) <50%、左室舒张内径 >65 毫米、左室收缩内径 (LVD) >50 毫米或 LVD/体表面积 > 25 毫米/平方米。多变量逻辑回归分析显示，AVR 前的高自然对数 (ln) C 反应蛋白 (CRP) 和低 LVEF 与 AVR 后的左室功能障碍显着相关（ln CRP：比值比 [OR] 4.15，95% 置信区间 [CI] 1.44–11.98，p< 0.01；LVEF：OR 0.79，95%CI 0.65–0.97，p < 0.05）。受试者操作特征分析显示，AVR 后左室功能障碍的 AVR 前 CRP 和 LVEF 曲线下面积分别为 0.84 和 0.83。根据AVR前阶段CRP（0.13 mg/dL）和LVEF（50%）的临界值将患者分为四组，低CRP（<0.13 mg/dL）和高LVEF（≥50%）组中没有患者（0/19）出现左室功能障碍，高CRP（≥0.13 mg/dL）和低LVEF组中所有患者（5/5）出现左室功能不全(<50%) 组 AVR 后出现左室功能障碍。结论 高 CRP 水平与 AVR 后左室功能障碍显着且独立相关。 CRP 和 LVEF 值的组合可能有助于预测 AVR 后 LV 功能的改善。
BackgroundWe aimed to clarify the predictive factors for left ventricular (LV) function after aortic valve replacement (AVR) in patients with aortic regurgitation (AR).Methods and resultsAmong 555 patients who underwent AVR at our institution from January 2015 to December 2020, we enrolled 44 patients for whom only AVR (or AVR + aortic replacement) was performed. We defined LV dysfunction under any of the following criteria: LV ejection fraction (LVEF) <50 %, LV diastolic dimension >65 mm, LV systolic dimension (LVDs) >50 mm, or LVDs/body surface area > 25 mm/m2. Multivariable logistic regression analysis revealed high natural logarithm (ln) C-reactive protein (CRP) and low LVEF in the pre-AVR period significantly associated with LV dysfunction after AVR (ln CRP: odds ratio [OR] 4.15, 95 % confidence interval [CI] 1.44–11.98,p< 0.01; LVEF: OR 0.79, 95%CI 0.65–0.97,p< 0.05). Receiver-operating characteristic analysis revealed an area under curve of CRP and LVEF in the pre-AVR period for LV dysfunction after AVR of 0.84 and 0.83, respectively. Upon dividing the patients into four groups according to cutoff values of CRP (0.13 mg/dL) and LVEF (50 %) in the pre-AVR period, no patients (0/19) had LV dysfunction in the low CRP (<0.13 mg/dL) and high LVEF (≥50 %) group, and all patients (5/5) in the high CRP (≥0.13 mg/dL) and low LVEF (<50 %) group had LV dysfunction after AVR.ConclusionHigh CRP level was significantly and independently associated with LV dysfunction after AVR. Combination of CRP and LVEF values might be useful for predicting improvement in LV function after AVR.