封硕,刘伟丽,屈占军,张振宇,江磊

• 1:青岛大学附属医院心外科
• 2:青岛大学附属医院介入手术室

摘要(Abstract)：

目的 探讨不同左心室射血分数（LVEF）水平的重度主动脉瓣反流（AR）患者经导管主动脉瓣置换术（TAVR）治疗后左心室逆重构时间动力学特征。方法 回顾性选取2018年5月至2024年8月于青岛大学附属医院接受TAVR治疗的重度AR患者65例，根据术前LVEF分为射血分数保留型AR(ARpEF)组（LVEF>53%,47例）和射血分数降低型AR(ARrEF)组（LVEF≤53%,18例）。对比两组术前及术后7 d、3个月、12个月的超声心动图参数变化，并采用重复测量方差分析评估时间效应及组间差异。结果 （1）术前两组患者均存在左心室扩张，且ARrEF组更明显，其左心室舒张末期内径指数[（33.71±2.57）mm/m~2比（29.53±3.61）mm/m~2,P<0.001]、左心室收缩末期内径指数[（24.41±2.16）mm/m~2比（19.73±3.58）mm/m~2,P<0.001]、左心室舒张末期容积指数[（99.95±30.52）ml/m~2比（78.06±18.20）ml/m~2,P=0.005]及左心室收缩末期容积指数[（44.35±13.58）ml/m~2比（26.53±6.53）ml/m~2,P<0.001]均高于ARpEF组，而LVEF低于ARpEF组[（43.07±6.61）%比（59.60±2.69）%,P<0.001]。（2）术后7 d，两组左心室结构参数均明显下降，ARpEF组左心室舒张末期内径指数降至（26.43±2.82）mm/m~2,ARrEF组降至（31.06±2.28）mm/m~2。两组左心室功能参数变化略有不同，ARpEF组LVEF下降至（57.00±5.23）%,ARrEF组升至（48.07±7.52）%。（3）术后7 d至3个月两组左心室内径和容积相关指标进一步下降，ARrEF组左心室收缩末期容积指数下降幅度较大。（4）术后3～12个月，各主要结构指标总体趋于稳定。结论 TAVR可促进重度AR患者左心室逆重构，其变化具有阶段性特征。术后7 d为急性容量卸载期，术后7 d至3个月可能是左心室几何重构与收缩功能较为活跃的阶段，术后3个月后进入巩固平台期。不同基线LVEF水平患者的逆重构轨迹存在差异。

关键词(KeyWords)： 主动脉瓣反流;左心室逆重构;经导管主动脉瓣置换术;射血分数;左心房长径

Abstract:

Keywords:

基金项目(Foundation): 国家科技重大专项项目（2024ZD0527100）

作者(Author): 封硕,刘伟丽,屈占军,张振宇,江磊

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