【摘要】 目的 比较接受经导管主动脉瓣置换术(TAVR)治疗的经典型低流量低压差主动脉瓣狭窄(cLFLG-AS)、正常流量低压差主动脉瓣狭窄(NFLG-AS)与高压差主动脉瓣狭窄(HG-AS)患者的临床特征和1年结局。方法 前瞻性、全国性、多中心China-DVD队列研究的事后分析。连续纳入2022年1月至2023年12月共5家心脏瓣膜中心接受TAVR治疗的858例重度AS患者,其中男性462例,占比53.8%。根据术前超声心动图参数将所有主动脉瓣口面积(AVA)<1cm~2的重度AS患者分为3组:(1)HG-AS组(683例):主动脉瓣跨瓣平均压差(MG)≥40mm Hg;(2)c LFLG-AS组(76例):MG<40mm Hg,左心室射血分数(LVEF)<50%,且每搏输出量指数(strokevolumeindex,SVI)<35ml/m~2;(3)NFLG-AS组(99例):MG<40mm Hg,LVEF≥50%且SVI≥35ml/m~2。通过多元logistic回归分析、Kalpan-Meier生存分析及Cox比例风险模型分析接受TAVR治疗后不同流量梯度AS患者的特征及1年结局。结果 与NFLG-AS组相比,cLFLG-AS组患者的左心室明显扩大[左心室舒张末内径:58.5(52.8,65.0)mm比46.0(43.0,50.0)mm],入院纽约心脏病协会(NYHA)心功能Ⅲ/Ⅳ级(85.5%比66.7%)和合并中度以上二尖瓣反流(56.6%比16.2%)的比例更高(均为P<0.05)。与HG-AS相比,左心室扩大与cLFLG-AS独立相关(OR=1.073,95%CI:1.035～1.112,P<0.001),而高血压(OR=1.871,95%CI:1.175～2.979,P=0.008)、较小的左心室(OR=0.945,95%CI:0.916～0.975,P<0.001)与NFLG-AS独立相关;与c LFLG-AS相比,较小的左心室与NFLG-AS独立相关(OR=0.869,95%CI:0.814～0.927,P<0.001)。NFLG-AS患者TAVR术后1年全因死亡率显著高于HG-AS(HR=3.163,95%CI:1.204～8.314,P=0.019)。结论 在TAVR患者中,左心室扩大在c LFLG-AS患者中更显著;与常见的HG-AS患者相比,NFLG-AS患者的预后则更差。更多还原

【Abstract】 Objective To compare the clinical characteristics and one-year outcomes among patients with classical low-flow,low-gradient aortic stenosis (c LFLG-AS),normal-flow,low-gradient AS(NFLG-AS),and high-gradient AS (HG-AS) undergoing transcatheter aortic valve replacement (TAVR).Methods This was a post hoc analysis of the prospective,multicenter China-DVD cohort.A total of 858patients with severe AS (AVA<1 cm~2) who underwent TAVR at five centers from January 2022 to December2023 were included.They were classified into three groups:HG-AS (n=683,MG≥40 mm Hg),c LFLG-AS (n=76,MG<40 mm Hg,LVEF<50%,SVI<35 ml/m~2),and NFLG-AS (n=99,MG<40 mm Hg,LVEF≥50%,SVI≥35 ml/m~2).Multivariate logistic regression analysis,Kaplan-Meier survival analysis,and Cox proportional hazards modeling were used to assess the characteristics and one-year outcomes among different AS subtypes after TAVR.Results Compared with the NFLG-AS group,the c LFLG-AS group had significantly enlarged left ventricles[left ventricular end-diastolic diameter:58.5 (52.8,65.0) mm vs.46.0 (43.0,50.0) mm,P<0.05],a higher proportion of NYHA classⅢ/Ⅳon admission (85.5%vs.66.7%,P<0.05),and more frequent moderate or greater mitral regurgitation (56.6%vs.16.2%,P<0.05).Compared with HG-AS,left ventricular enlargement was independently associated with c LFLG-AS(OR=1.073,95%CI:1.035-1.112,P<0.001),whereas hypertension (OR=1.871,95%CI:1.175-2.979,P=0.008) and smaller left ventricular size (OR=0.945,95%CI:0.916-0.975,P<0.001) were independently associated with NFLG-AS.Compared with c LFLG-AS,smaller left ventricular size was also independently associated with NFLG-AS (OR=0.869,95%CI:0.814-0.927,P<0.001).The one-year all-cause mortality after TAVR was significantly higher in the NFLG-AS group compared to the HG-AS group(HR=3.163,95%CI:1.204-8.314,P=0.019).Conclusions Among patients undergoing TAVR,left ventricular enlargement is more prominent in those with c LFLG-AS.Compared with the more common HG-AS subtype,patients with NFLG-AS exhibit worse prognosis.更多还原