在PARTNER 2试验和注册中,在大动脉置换后,左和右心室纵向缩功能在PARTNER 2试验和注册中出现
Iria Silva1,2, Julien Ternacle3, Rebecca T Hahn4
1Department of Cardiology, Québec Heart & Lung Institute, Laval University, 2725 chemin Ste-Foy, Quebec City, Québec G1V-4G5, Canada.
European heart journal. Cardiovascular Imaging
|May 2, 2024
概括
手术性大动脉置换 (SAVR) 显著恶化了右心室功能和RV-肺动脉 (RV-PA) 合,与跨导管大动脉置换 (TAVR) 不同. 较低的RV功能和RV-PA合预测AVR后更糟糕的结果.
科学领域:
- 心脏病学 心脏病学
- 心血管外科心血管外科
- 心声回声扫描 (Echocardiography) 是一种心声回声扫描.
背景情况:
- 左心室和右心室 (RV) 纵向静脉功能评估有助于在大动脉置换 (AVR) 后的风险分层.
- 了解AVR后的RV功能和RV-肺动脉 (RV-PA) 合的变化对于患者的治疗结果至关重要.
研究的目的:
- 从基线到AVR1年后,评估左侧和RV纵向心功能和RV-PA合的变化.
- 为了比较手术AVR (SAVR) 和透导管AVR (TAVR) 之间的这些变化.
主要方法:
- 来自PARTNER 2A SAVR手臂 (n=985) 和PARTNER 2 SAPIEN 3注册表 (n=719) 的患者的分析.
- 在基线,30天和AVR后1年内对左心室纵向应变 (LS),三环平面缩外流 (TAPSE) 和RV-PA合的评估.
主要成果:
- 在SAVR之后,TAPSE和RV-PA的合显著下降,但在TAVR之后保持稳定.
- 较低的基线LV LS,TAPSE或RV-PA合预测5年死亡,住院或中风风险增加.
- 降低基线TAPSE是5年复合结果的最强预测因素;较低的30天RV-PA合强烈预测了心脏死亡率.
结论:
- 与TAVR不同的是,SAVR导致了RV纵向缩功能和RV-PA合的显著恶化.
- 较低的TAPSE和RV-PA合在30天后与较差的5年临床结果相关.
- 在患者中,TAVR在基线左心室喷射率<50%的患者中显示出优异的5年结局.
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