PDF(Pubmed)
Abstract：
BACKGROUND: Cardiac fibrosis plays a major pathophysiological role in any form of chronic heart disease, and high levels are associated with poor outcome. Diffuse and focal cardiac fibrosis are different subtypes, which have different pathomechanisms and prognostic implications. The total fibrosis burden in endomyocardial biopsy tissue was recently proved to play an independent prognostic role in aortic stenosis patients after transcatheter aortic valve implantation (TAVI).
OBJECTIVE: Here, for the first time, we aim to assess the specific impact of different fibrosis subtypes on sudden cardiac death (SCD) as a primary reason for cardiovascular mortality after TAVI.
METHODS: The fibrosis pattern was assessed histologically in the left ventricular biopsies obtained during TAVI interventions in 161 patients, who received a structured follow-up thereafter.
RESULTS: Receiver operating characteristic analyses, performed 6, 12, 24 and 48 months after TAVI, showed diffuse, but not focal, fibrosis as a significant predictor for SCD at all timepoints, with the highest area under the curve at the first time point and a decrease in its SCD predictivity over time. In both multivariate Cox proportional hazards and Fine-Gray competing risk models, including both fibrosis subtypes, as well as age, sex and ejection fraction, high diffuse fibrosis remained statistically significant. Accordingly, it represents an independent SCD predictor, most importantly for the occurrence of early events.
CONCLUSIONS: The burden of diffuse cardiac fibrosis plays an important and independent prognostic role regarding SCD early after TAVI. Therefore, the histological evaluation of fibrosis topography has value as a prognostic tool for TAVI patients and may help to tailor individualised approaches to optimise their postinterventional management.
OBJECTIVE: Here, for the first time, we aim to assess the specific impact of different fibrosis subtypes on sudden cardiac death (SCD) as a primary reason for cardiovascular mortality after TAVI.
METHODS: The fibrosis pattern was assessed histologically in the left ventricular biopsies obtained during TAVI interventions in 161 patients, who received a structured follow-up thereafter.
RESULTS: Receiver operating characteristic analyses, performed 6, 12, 24 and 48 months after TAVI, showed diffuse, but not focal, fibrosis as a significant predictor for SCD at all timepoints, with the highest area under the curve at the first time point and a decrease in its SCD predictivity over time. In both multivariate Cox proportional hazards and Fine-Gray competing risk models, including both fibrosis subtypes, as well as age, sex and ejection fraction, high diffuse fibrosis remained statistically significant. Accordingly, it represents an independent SCD predictor, most importantly for the occurrence of early events.
CONCLUSIONS: The burden of diffuse cardiac fibrosis plays an important and independent prognostic role regarding SCD early after TAVI. Therefore, the histological evaluation of fibrosis topography has value as a prognostic tool for TAVI patients and may help to tailor individualised approaches to optimise their postinterventional management.
摘要：
背景：心脏纤维化在任何形式的慢性心脏病中都起着重要的病理生理作用，高水平与不良结果相关。弥漫性和局灶性心脏纤维化是不同的亚型，具有不同的病理机制和预后意义。心内膜活检组织的总纤维化负荷最近被证明在经导管主动脉瓣植入术（TAVI）后的主动脉瓣狭窄患者中起独立的预后作用。
目标：这里，第一次,我们旨在评估不同纤维化亚型对作为TAVI术后心血管死亡的主要原因的心源性猝死(SCD)的具体影响.
方法：在161例患者的TAVI干预期间获得的左心室活检中，对纤维化模式进行了组织学评估，此后接受了结构化的随访。
结果：接收机工作特性分析，在TAVI后6、12、24和48个月进行，表现为弥漫性，但不是焦点，纤维化在所有时间点都是SCD的重要预测因子，在第一时间点的曲线下面积最高，并且随着时间的推移其SCD预测性降低。在多元Cox比例风险和精细-灰色竞争风险模型中，包括两种纤维化亚型，以及年龄,性别和射血分数，高弥漫性纤维化仍有统计学意义.因此，它代表一个独立的SCD预测因子，最重要的是早期事件的发生。
结论：弥漫性心肌纤维化的负担对TAVI后早期SCD具有重要且独立的预后作用。因此,纤维化地形图的组织学评估作为TAVI患者的预后工具具有价值,并且可能有助于定制个性化方法以优化其介入后管理.
目标：这里，第一次,我们旨在评估不同纤维化亚型对作为TAVI术后心血管死亡的主要原因的心源性猝死(SCD)的具体影响.
方法：在161例患者的TAVI干预期间获得的左心室活检中，对纤维化模式进行了组织学评估，此后接受了结构化的随访。
结果：接收机工作特性分析，在TAVI后6、12、24和48个月进行，表现为弥漫性，但不是焦点，纤维化在所有时间点都是SCD的重要预测因子，在第一时间点的曲线下面积最高，并且随着时间的推移其SCD预测性降低。在多元Cox比例风险和精细-灰色竞争风险模型中，包括两种纤维化亚型，以及年龄,性别和射血分数，高弥漫性纤维化仍有统计学意义.因此，它代表一个独立的SCD预测因子，最重要的是早期事件的发生。
结论：弥漫性心肌纤维化的负担对TAVI后早期SCD具有重要且独立的预后作用。因此,纤维化地形图的组织学评估作为TAVI患者的预后工具具有价值,并且可能有助于定制个性化方法以优化其介入后管理.
