PDF(Pubmed)
Abstract：
Background/Objectives: Severe aortic stenosis (AS) is the most frequent valvular heart disease. Models for stratifying cardiac damage associated with aortic stenosis have been developed to predict outcomes following valve replacement. However, evidence regarding morphological and functional evolution, as well as potential changes in the degree of cardiac damage, is limited. We aim to provide information on the evolution of cardiac morphology and the function of patients undergoing transcatheter aortic valve replacement (TAVR) who have been classified using a cardiac damage staging system. Methods: In total, 496 patients were included in the analysis, and were classified into four stages based on the extent of cardiac damage as follows: Stage 0, no cardiac damage: left ventricle global longitudinal strain (LV-GLS) < -17%; right ventricular-arterial coupling (RVAc) ≥ 0.35), and absence of significant mitral regurgitation (MR). Stage 1, left-sided subclinical damage: LV-GLS ≥ -17%. Stage 2, left-sided damage: significant MR. Stage 3, right-sided damage: RVAc < 0.35. Results: The mean age was 82.1 ± 5.9 years, and 53.0% were female. In total, 24.5% of patients met the criteria for Stage 0, and Stage 1 included 42.8% of patients, Stage 2 included 16.5%, and Stage 3 comprised 16.2% of patients. Mortality was 8.4% for stage 0, 17.4% for stage 1, 25.6% for stage 2, and 28.6% for stage 3 patients (p = 0.004). Diabetes mellitus (DM) (p = 0.047) and chronic kidney disease (CKD) (p = 0.024) were the only clinical predictors of no change or worsening in the stage of cardiac damage. Regarding echocardiographic variables, concomitant tricuspid, and mitral regurgitation, ≥ 2 were both significantly associated with no change or worsening, also (p < 0.001). Conclusions: Cardiac damage that is secondary to severe aortic stenosis has morphological and functional repercussions that, even after valve replacement, persist and might worsen the prognosis.
摘要：
背景/目的：重度主动脉瓣狭窄（AS）是最常见的心脏瓣膜病。已经开发了与主动脉瓣狭窄相关的分层心脏损伤模型来预测瓣膜置换后的结果。然而,关于形态和功能进化的证据，以及心脏损伤程度的潜在变化，是有限的。我们旨在提供有关心脏形态演变的信息以及使用心脏损伤分期系统分类的经导管主动脉瓣置换术（TAVR）患者的功能。方法：总计，496名患者被纳入分析，根据心脏损伤的程度分为四个阶段：0期，无心脏损伤：左心室整体纵向应变（LV-GLS）<-17％；右心室-动脉耦合（RVAc）≥0.35），并且没有明显的二尖瓣反流（MR）。1期，左侧亚临床损伤：LV-GLS≥-17%。第二阶段，左侧损伤：显著MR。第3阶段，右侧损伤：RVAc<0.35。结果：平均年龄为82.1±5.9岁，53.0%为女性。总的来说,24.5%的患者符合0期标准，1期包括42.8%的患者，第二阶段包括16.5%，3期患者占16.2%。0期患者的死亡率为8.4％，1期患者为17.4％，2期患者为25.6％，3期患者为28.6％（p=0.004）。糖尿病（DM）（p=0.047）和慢性肾脏疾病（CKD）（p=0.024）是心脏损伤阶段无变化或恶化的唯一临床预测因子。关于超声心动图变量，伴随三尖瓣，和二尖瓣反流,≥2与无变化或恶化显著相关，（p<0.001）。结论：严重主动脉瓣狭窄继发的心脏损害具有形态学和功能性影响，即使在瓣膜更换后，持续存在并可能恶化预后。
