Assessment of valve haemodynamics, reverse ventricular remodelling and myocardial fibrosis following transcatheter aortic valve implantation compared to surgical aortic valve replacement: a cardiovascular magnetic resonance study

被引：94

作者：

Fairbairn, Timothy A. ^{[1
]}

Steadman, Christopher D. ^{[2
,3
]}

Mather, Adam N. ^{[1
]}

Motwani, Manish ^{[1
]}

Blackman, Daniel J. ^{[4
]}

Plein, Sven ^{[1
,4
]}

McCann, Gerry P. ^{[2
,3
]}

Greenwood, John P. ^{[1
,4
]}

机构：

[1] Univ Leeds, Multidisciplinary Cardiovasc Res Ctr, Leeds Inst Genet Hlth & Therapeut, Leeds LS1 3EX, W Yorkshire, England

[2] Univ Leicester, Dept Cardiovasc Sci, Leicester, Leics, England

[3] Natl Inst Hlth Res, Leicester Cardiovasc Biomed Res Unit, Leicester, Leics, England

[4] Leeds Gen Infirm, Dept Cardiol, Leeds, W Yorkshire, England

来源：

HEART | 2013年 / 99卷 / 16期

关键词：

STENOSIS; DISEASE; QUANTIFICATION; HYPERTROPHY; HEALTH; MRI;

D O I：

10.1136/heartjnl-2013-303927

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Objective To compare the effects of transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR) on aortic valve haemodynamics, ventricular reverse remodelling and myocardial fibrosis (ME) by cardiovascular magnetic resonance (CMR) imaging. Design A 1.5 T CMR scan was performed preoperatively and 6 months postoperatively. Setting University hospitals of Leeds and Leicester, UK. Patients 50 (25 TAVI, 25 SAVR; age 77 +/- 8 years) highrisk severe symptomatic aortic stenosis (AS) patients. Main outcome measures Valve haemodynamics, ventricular volumes, ejection fraction (EF), mass and ME. Results Patients were matched for gender and AS severity but not for age (80 6 vs 73 +/- 7 years, p=0.001) or EuroSCORE (22 +/- 14 vs 7 +/- 3, p<0.001). Aortic valve mean pressure gradient decreased to a greater degree post-TAVI compared to SAVR (21 +/- 8 mm Hg vs 35 +/- 13 mm Hg, p=0.017). Aortic regurgitation reduced by 8% in both groups, only reaching statistical significance for TAVI (p=0.003). TAVI and SAVR improved (p<0.05) left ventricular (LV) end-systolic volumes (46 +/- 18 ml/m(2) vs 41 +/- 17 ml/m(2); 44 +/- 22 ml/m(2) vs32 +/- 6 ml/m(2)) and mass (83 +/- 20 g/m(2) vs 65 +/- 15 g/m(2); 74 +/- 11 g/m(2) vs 59 +/- 8 g/m(2)). SAVR reduced end-diastolic volumes (92 +/- 19 ml/m(2) vs 74 +/- 12 ml/m(2), p<0.001) and TAVI increased EF (52 +/- 12% vs 56 +/- 10%, p=0.01). ME reduced post-TAVI (10.9 6% vs 8.5 5%, p=0.03) but not post-SAVR (4.2 +/- 2% vs 4.1 +/- 2%, p=0.98). Myocardial scar (p<0.01) and baseline ventricular volumes (p<0.001) were the major predictors of reverse remodelling. Conclusions TAVI was comparable to SAVR at LV reverse remodelling and superior at reducing the valvular pressure gradient and ME. Future work should assess the prognostic importance of reverse remodelling and fibrosis post-TAVI to aid patient selection.

引用

页码：1185 / 1191

页数：7

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