Influence of left ventricular diastolic function on prognosis of patients with aortic stenosis immediately after transcatheter aortic valve replacement
10.3760/cma.j.cn131148-20240714-00380
- VernacularTitle:经导管主动脉瓣置换术后即刻左心室舒张功能变化对主动脉瓣狭窄患者预后的影响
- Author:
Xiejing LONG
1
;
Huili LIANG
;
Yue QIU
;
Liang GUO
;
Chunyan MA
;
Xin CHEN
Author Information
1. 中国医科大学附属第一医院心血管超声科 辽宁省影像医学临床医学研究中心，沈阳 110001
- Publication Type:Journal Article
- Keywords:
Echocardiography;
Aortic stenosis;
Transcatheter aortic valve replacement;
Diastolic function;
Prognosis
- From:
Chinese Journal of Ultrasonography
2024;33(12):1030-1036
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the effect of changes of left ventricular diatolic function immediately after transcatheter aortic valve replacement (TAVR) on the prognosis of TAVR.Methods:A total of 80 patients undergoing TAVR treatment were retrospectively enrolled from October 2017 to February 2023 in the Department of Cardiology of the First Hospital of China Medical University. Demographic data, imaging parameters, laboratory data and operation data were recorded. Patients were followed up at 30 days and 1 year after TAVR through clinic or telephone visits. The changes of diastolic function parameters before and immediately after TAVR were analyzed. When the improvement of left ventricular diastolic function grade≥1 grade was defined as the improvement of diastolic function. Included patients were divided into left ventricular diastolic disfunction (LVDD) improvement group and non-improvement group. The primary endpoint was the composite outcome of 1-year all-cause mortality and cardiovascular rehospitalization. The diffferences of adverse events between two groups were analyzed, and univariate and multivariate Cox regression analysis were used to explore the predictors of the primary adverse events of TAVR.Results:Improvement in LVDD grade was seen in 30 (37.5%) patients immediately after TAVR. Patients with improvement in ≥1 grade of LVDD had less 1-year death/cardiovascular rehospitalization than patients in non-improvement group(6.7% vs 28.0%, P=0.021). Multivariate Cox proportional hazards models showed that improvement in LVDD grade immediately after TAVR was an independent protective factor for 1-year death/cardiovascular rehospitalization ( HR=0.103, 95% CI=0.021-0.502, P=0.005), while diabetes mellitus ( HR=4.035, 95% CI=1.294-12.584, P=0.016), society of thoracic surgeons (STS) score ( HR=1.253, 95% CI=1.015-1.421, P<0.001), intensive care unit (ICU) stay ( HR=1.198, 95% CI=1.012-1.418, P=0.036), and aortic valve area (AVA) ( HR=1.079, 95% CI =1.039-1.121, P<0.001) were independent risk factors for 1-year death/cardiovascular rehospitalization. Conclusions:The improved left ventricular diastolic function is experienced in 37.5% of patients immdiately after TAVR, and patients with improvement in LVDD grade immediately after TAVR has less 1-year death/cardiovascular rehospitalization, which is an independent protective factor for 1-year death/cardiovascular rehospitalization, while diabetes mellitus, STS score, ICU stay and AVA are independent risk factors for 1-year death/cardiovascular rehospitalization.
