背景:传导障碍对经导管主动脉瓣置换术(TAVR)后的长期左心室射血分数(LVEF)具有不确定性。我们旨在检查TAVR后两年内患者的LVEF变化。
方法:我们检查了2012年至2020年接受TAVR的患者,并进行了超声心动图随访。患者分为四组:1)TAVR前后无永久性起搏器(PPM)或左束支传导阻滞(LBBB)的患者;2)TAVR前后LBBB的患者;3)先前存在PPM的患者;4)TAVR后需要新PPM的患者。LVEF在TAVR开始时进行了评估,在30天,1年,和2年后TAVR。
结果:该研究包括730例患者:421例(57.6%)无传导异常,151(20.7%)具有TAVR后LBBB(48个预先存在,103新发),63(8.6%),具有预先存在的PPM,95(13.1%)需要新的PPM。出院时,没有传导异常的患者表现出最高的LVEF(57.4±11.5%),而那些预先存在PPM的人最低(48.1±15.5%).两年多了,在没有传导问题的患者和具有预先存在的PPM的患者中,LVEF保持恒定。然而,新的LBBB患者的LVEF下降了6.3%,和那些需要新的PPM显示减少4.1%。
结论:新的传导异常,例如LBBB或PPM的需要,诱导LVEF下降后TAVR。必须将重点放在TAVR后经历新的传导障碍的患者的左心室功能的长期监测上。
BACKGROUND: Conduction disturbances have uncertain implications for long-term left ventricular ejection fraction (LVEF) after transcatheter aortic valve replacement (TAVR). We aimed to examine LVEF changes in patients up to two years post-TAVR.
METHODS: We examined patients who underwent TAVR between 2012 and 2020 and underwent echocardiography follow-up. Patients were categorized into four groups: 1) Those without a permanent
pacemaker (PPM) or left bundle branch block (LBBB) pre- or post-TAVR; 2) Patients with pre- and post-TAVR LBBB; 3) Individuals with preexisting PPM; and 4) Patients requiring new PPM after TAVR. LVEF was assessed at the outset of TAVR, at 30 days, 1-year, and 2-years post-TAVR.
RESULTS: The study included 730 patients: 421 (57.6 %) without conduction abnormalities, 151 (20.7 %) with post-TAVR LBBB (48 pre-existing, 103 new-onset), 63 (8.6 %) with pre-existing PPM, and 95 (13.1 %) requiring new PPM. At discharge, patients without conduction abnormalities exhibited the highest LVEF (57.4 ± 11.5 %), whereas those with pre-existing PPM had the lowest (48.1 ± 15.5 %). Over two years, LVEF remained constant in patients without conduction issues and in those with pre-existing PPM. However, patients with new LBBB experienced a 6.3 % decrease in LVEF, and those requiring new PPM showed a 4.1 % reduction.
CONCLUSIONS: New conduction abnormalities, such as LBBB or the need for PPM, induce a decline in LVEF post-TAVR. It is imperative to focus on the long-term monitoring of left ventricular function in patients experiencing new conduction disturbances post-TAVR.