吴比,刘然,刘若云,戴枚芳,闫雪,闫云峰,赵丽,阴赪茜,宋光远

• 1:北京体育大学运动人体科学学院
• 2:首都医科大学附属北京安贞医院心脏瓣膜病介入中心

摘要(Abstract)：

目的 探讨重度主动脉瓣狭窄患者接受经导管主动脉瓣置换术（TAVR）前合并心肌损伤对术后心脏逆重构及临床结局的影响。方法 连续纳入2021年5月至2024年1月首都医科大学附属北京安贞医院心脏瓣膜病介入中心接受TAVR的症状性重度主动脉瓣狭窄患者408例，按术前心肌肌钙蛋白I(cTnI)分为cTnI阳性组218例（53.4%）和cTnI阴性组190例（46.6%）。收集术前及术后1、6、12个月超声心动图参数，分析两组冠状动脉狭窄分布及左心室质量指数（LVMi）变化，并采用Kaplan-Meier及Cox比例风险模型评估cTnI对术后1年心脏逆重构及复合终点（全因死亡和心力衰竭再住院）的影响。结果 cTnI阳性组左心室间隔厚度、左心室后壁厚度、三尖瓣肺动脉收缩压、二尖瓣口血流舒张早期最大流速（E峰）与舒张晚期最大流速（A峰）比值（E/A）及LVMi均高于cTnI阴性组，而左心室射血分数（LVEF）低于cTnI阴性组，差异均有统计学意义（均P<0.05）。术前cTnI阳性组患者中无重塑、轻度重塑、中度重塑和重度重塑分别占9.9%、15.7%、16.5%和57.9%，以重度重塑为主；而cTnI阴性组以无重塑和轻度重塑为主。术后12个月，cTnI阳性组上述4类患者分别占34.1%、20.7%、19.5%和25.6%，而cTnI阴性组仍以无重塑为主。两组术前及术后12个月重塑等级分布比较差异均有统计学意义（均P<0.001）。cTnI阳性组在术后即刻及随访1、6、12个月时LVMi均显著高于cTnI阴性组，差异均有统计学意义（均P<0.001）。cTnI阳性组全因死亡和心力衰竭再住院复合终点事件发生率高于cTnI阴性组（6.0%比1.1%,P=0.008）。多因素Cox回归分析显示，术前cTnI阳性是复合终点事件的独立危险因素（HR 5.520,95%CI 1.234～24.694,P=0.025）。结论 TAVR术前合并心肌损伤患者占53.4%，其术后1年LVMi仍高于cTnI阴性患者，并与全因死亡及心力衰竭再住院风险的增加密切相关。

关键词(KeyWords)： 主动脉瓣狭窄;经导管主动脉瓣置换术;心肌损伤;心肌重塑

Abstract:

Keywords:

基金项目(Foundation): 国家重点研发计划项目（2022YFC3600201）

作者(Author): 吴比,刘然,刘若云,戴枚芳,闫雪,闫云峰,赵丽,阴赪茜,宋光远

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