经导管主动脉瓣置后早期左心室逆向重构——肺动脉高压在其中的角色
Early Reverse Remodeling of the Left Ventricle after Transcatheter Aortic Valve Placement—The Role of Pulmonary Hypertension
摘要: 目的：通过对TAVR患者进行随访，了解术前肺动脉高压对于术后左心室逆向重构的影响。方法与结果：该研究包括2017年9月至2020年12月期间于青岛大学附属医院接受TAVR的主动脉狭窄患者资料。按术前有无肺动脉收缩压(PASP)值将患者分为PH组与n-PH组，并对两组患者TAVR术后左心室逆向重构及相关因素进行对比分析。共纳入67例经导管主动脉瓣置入术前测量PASP的患者，PH组在基线时表现为较高的欧洲评分及较重的二尖瓣返流；两组患者术后仅表现为PH组的住院时间较长。死亡率及不良事件发生率无统计学意义。两组患者术后的左心质量分数及相对室壁厚度均在1年内有明显的改善。其中，PH组在术后3个月内改善明显，但两组患者左心仍未逆转至正常水平。结论：患者接受TAVR治疗后，随着时间的推移左心室发生明显的逆向重构。术前合并有肺动脉高压的患者在术后逆向重构程度弱于无肺动脉高压患者。术前有无肺动脉高压，其术后短期生存率与死亡率无明显差异。
Abstract: Objective: To investigate the effect of preoperative pulmonary arterial hypertension on postoperative left ventricular reverse remodeling by following up patients with TAVR. Methods & Results: Data of patients with aortic stenosis who underwent TAVR at the Affiliated Hospital of Qingdao University between September 2017 and December 2020 were included in this study. Patients were divided into PH group and n-PH group according to the preoperative value of pulmonary artery systolic pressure (PASP), and left ventricular reverse remodeling and related factors after TAVR in the two groups were compared and analyzed. A total of 67 patients with preoperative PASP were included. The PH group had a higher European score and heavier mitral regurgitation at baseline. Patients in both groups showed only a longer postoperative hospital stay in the PH group. The mortality and adverse events were not statistically significant. The left ventricular mass fraction and relative ventricular wall thickness were significantly improved in 2 groups within 1 year. Among them, the PH group improved significantly within 3 months after surgery, but the left heart of patients in both groups did not reverse to normal level. Conclusion: After TAVR treatment, there is significant reverse remodeling of the left ventricle over time. The degree of reverse remodeling in patients with preoperative pulmonary hypertension is weaker than that in patients without. There was no significant difference in short-term survival and mortality between patients with or without preoperative pulmonary hypertension.
文章引用：张甲易, 杨宝童, 江磊. 经导管主动脉瓣置后早期左心室逆向重构——肺动脉高压在其中的角色[J]. 临床医学进展, 2021, 11(7): 3018-3026. https://doi.org/10.12677/ACM.2021.117439

参考文献

[1] Faggiano, P., Antonini-Canterin, F., ribichini, F., et al. (2000) Pulmonary Artery Hypertension in Adult Patients with Symptomatic Valvular Aortic Stenosis. The American Journal of Cardiology, 85, 204-208. [Google Scholar] [CrossRef] 
[2] Bruno, A.G., Santona, L., Palmerini, T., et al. (2020) Predicting and Improving Outcomes of Transcatheter Aortic Valve Replacement in Older Adults and the Elderly. Expert Review of Cardiovascular Therapy, 18, 663-680. [Google Scholar] [CrossRef] [PubMed]
[3] Price, J., Bob-Manuel, T., Aymond, J., et al. (2020) Low Risk TAVR: Long-Term Considerations and Appropriate Patient Selection. Progress in Cardiovascular Diseases, 63, 377-382. [Google Scholar] [CrossRef] [PubMed]
[4] Masri, A., Abdelkarim, I., Sharbaugh, M.S., et al. (2018) Outcomes of Persistent Pulmonary Hypertension Following Transcatheter Aortic Valve Replacement. Heart, 104, 821-827.
[5] Ben-Yehuda, O., Shahim, B., Chen, S., et al. (2020) Pulmonary Hypertension in Transcatheter Mitral Valve Repair for Secondary Mitral Regurgitatio. Journal of the American College of Cardiology, 76, 2595-2606. [Google Scholar] [CrossRef] [PubMed]
[6] Brunner, N.W., Yue, S.F., Stub, D., et al. (2017) The Prognostic Importance of the Diastolic Pulmonary Gradient, Transpulmonary Gradient, and Pulmonary Vascular Resistance in Patients Undergoing Transcatheter Aortic Valve Replacement. Catheterization and Cardiovascular Interventions, 90, 1185-1191.
[7] Huang, W.M., Feng, J.Y., Cheng, H.M., et al. (2020) The Role of Pulmonary Function in Patients with Heart Failure and Preserved Ejection Fraction: Looking beyond Chronic Obstructive Pulmonary Disease. PLoS ONE, 15, e0235152. [Google Scholar] [CrossRef] [PubMed]
[8] Alushi, B., Beckhoff, F., Leistner, D., et al. (2018) Pulmonary Hypertension in Patients with Severe Aortic Stenosis: Prognostic Impact after Transcatheter Aortic Valve Replacement. JACC: Cardiovascular Imaging, 12, 591-601.
[9] Chen, J., Nawaz, N., Fox, Z., et al. (2016) Echocardiographic Determinants of LV Functional Improvement after Transcatheter Aortic Valve Replacement. Catheterization and Cardiovascular Interventions, 87, 1164-1172. [Google Scholar] [CrossRef] [PubMed]
[10] Ujihira, K., Kohmoto, T., Gimelli, G., Raval, A., Jacobson, K., Wolff, M. and Osaki, S. (2020) The Impact of Increased Pulmonary Arterial Pressure on Outcomes after Transcatheter Aortic Valve Replacement. Catheterization and Cardiovascular Interventions, 96, E723-E734. [Google Scholar] [CrossRef] [PubMed]
[11] Hernandez-Suarez, D.F., Menendez, F., Palm, D., et al. (2017) Left Ventricular Diastolic Function Assessment of a Heterogeneous Cohort of Pulmonary Arterial Hypertension Patients. Journal of Clinical Medicine Research, 9, 353-359. [Google Scholar] [CrossRef] [PubMed]
[12] Boos, C.J., Hodkinson, P., Mellor, A., Green, N.P. and Woods, D.R. (2012) The Effects of Acute Hypobaric Hypoxia on Arterial Stiffness and Endothelial Function and Its Relationship to Changes in Pulmonary Artery Pressure and Left Ventricular Diastolic Function. High Altitude Medicine & Biology, 13, 105-111. [Google Scholar] [CrossRef] [PubMed]
[13] Bishu, K., Suri, R.M., MD, Nkomo, V.T., et al. (2014) Prognostic Impact of Pulmonary Artery Systolic Pressure in Patients Undergoing Transcatheter Aortic Valve Replacement for Aortic Stenosis. American Journal of Cardiology, 114, 1562-1567. [Google Scholar] [CrossRef] [PubMed]
[14] Lin, C.T., Czarny, M.J., Hussien, A., et al. (2020) Fibrotic Lung Disease at CT Predicts Adverse Outcomes in Patients Undergoing Transcatheter Aortic Valve Replacement. Radiology: Cardiothoracic Imaging, 2, e190093. [Google Scholar] [CrossRef] [PubMed]

为你推荐