孙猛,陈璐琳,白景云,严丽洁,刘静静,范宪伟,李雪洁,胡娟,吴金涛,杨海涛

• 1:阜外华中心血管病医院郑州大学华中阜外医院心内科

摘要(Abstract)：

目的 本研究旨在评估经导管主动脉瓣置换术（TAVR）对混合性主动脉瓣疾病（MAVD）和主动脉瓣狭窄（AS）患者左心室逆重构（LVRR）和预后的影响。方法 连续收集2020年1月至2022年12月于阜外华中心血管病医院行TAVR的患者149例（AS组79例，MAVD组70例）。1﹕1倾向性评分匹配用于控制患者选择偏倚。经胸超声心动图用于监测左心室射血分数及其他结构参数。研究终点为心血管死亡和心血管相关再住院的复合终点。线性混合效应模型和Logistic回归分别用于比较两组间超声心动图的动态变化和识别LVRR的相关危险因素。结果 1﹕1倾向性评分匹配后，共纳入126例患者。MAVD组TAVR术前存在更大的结构参数[左心室收缩/舒张末期内径/容积、左心室质量指数（LVMI）]和更低的左心室射血分数（LVEF）（均P<0.05），但在随访中观察到更为显著的左心室结构和血流动力学改善。多变量Logistic回归分析显示，LVMI是TAVR术后LVRR的独立预测因素（OR 1.016,95%CI 1.001～1.030），而术后仍持续存在的中度及以上二尖瓣反流（OR 0.187,95%CI0.047～0.749）和瓣周漏（OR 0.313,95%CI 0.107～0.917）则显著降低LVRR的发生率。在23个月的中位随访期间，共发生31例终点事件，经倾向性评分匹配后，两组间的长期预后差异无统计学意义（Logrank P=0.330）。结论 与AS组患者相比，MAVD组患者在TAVR术前存在更严重的左心室重构，但术后随访中观察到更显著的LVRR。此外，两组患者在TAVR术后的长期预后差异无统计学意义。

关键词(KeyWords)： 左心室逆重构;混合性主动脉瓣疾病;主动脉瓣狭窄;经导管主动脉瓣置换术

Abstract:

Keywords:

基金项目(Foundation): 河南省医学科技攻关计划项目（LHGJ20190784）

作者(Author): 孙猛,陈璐琳,白景云,严丽洁,刘静静,范宪伟,李雪洁,胡娟,吴金涛,杨海涛

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