体重指数对重度主动脉瓣狭窄患者经导管主动脉瓣置换术围术期及远期预后的影响

Impact of Body Mass Index on Perioperative and Long-term Prognosis of Transcatheter Aortic Valve Replacement in Patients With Severe Aortic Stenosis

目的:探讨体重指数(BMI)对重度主动脉瓣狭窄患者经导管主动脉瓣置换术(TAVR)围术期及远期预后的影响。方法:回顾性收集2019年1月至2022年1月于福建省立医院行TAVR治疗的重度主动脉瓣狭窄患者180例,根据BMI分为低体重组(BMI<18.5 kg/m^(2),n=23)、体重正常组(18.5 kg/m^(2)≤BMI<24.0 kg/m^(2),n=65)、超重组(24.0kg/m^(2)≤BMI<28.0 kg/m^(2),n=57)和肥胖组(BMI≥28.0 kg/m^(2),n=35)。比较各组一般临床资料、影像学参数、围术期指标和随访期间的全因死亡及其他远期不良心血管事件发生率,同时评估TAVR围术期并发症及远期预后的影响因素。结果:肥胖组的高血压及糖尿病比例、左心室舒张末期内径、室间隔厚度以及左心室后壁厚度均高于正常组(P均<0.05)。低体重组的前白蛋白水平低于正常组(P<0.05),低体重组围术期总体并发症发生率高于正常组(60.9%vs.12.3%,P=0.042)。随访(18.0±6.8)个月期间,低体重组的全因死亡率明显高于体重正常组、超重组和肥胖组(17.4%vs.4.6%vs.3.5%vs.5.7%,P=0.003)。Kaplan-Meier生存分析显示,低体重组TAVR术后18个月的生存率明显降低(log-rank P<0.01)。多因素Cox回归分析结果显示,与正常体重组比较,低体重组远期不良心血管事件发生风险明显增加(HR=7.633,95%CI:1.012~57.564,P=0.049)。结论:低体重的重度主动脉瓣狭窄患者TAVR围术期并发症的发生率较高,远期预后较差。这类患者在行TAVR前应适当加强营养摄入,调整自身体重至正常水平。

Objectives:To investigate the effect of body mass index(BMI) on perioperative and long-term prognosis of patients with severe aortic stenosis(AS) after transcatheter aortic valve replacement(TAVR).Methods:This retrospective study imcluded 180 patients with severe AS who received TAVR in Fujian Provincial Hospital from January 2019 to January 2022.According to the BMI,patients were divided into four groups:low weight group(BMI<18.5 kg/m~2,n=23),normal weight group(18.5 kg/m~2≤BMI<24.0 kg/m~2,n=65),overweight group(24.0 kg/m~2≤BMI<28.0 kg/m~2,n=57),obesity group(BMI≥28.0 kg/m~2,n=35).The general clinical characteristics,imaging parameters,perioperative indexes,all-cause death and the incidence of other adverse cardiac events during(18.0±6.8) months followup were compared among different groups.Risk factors for the perioperative complications and long-term outcomes of TAVR were evaluated.Results:The prevalence of hypertension and diabetes,left ventricular end-diastolic diameter,ventricular septal thickness and left ventricular posterior wall thickness were significantly higher in the obese group than in normal weight group(all P<0.05).The level of prealbumin in low weight group was lower than in normal weight group(P<0.05).The total perioperative complications in low weight group were higher than in normal weight group(60.9% vs.12.3%,P=0.042).During(18.0±6.8)months follow-up,the incidence of all-cause death in the low weight group was significantly higher than that in normal weight group,overweight group and obese group(17.4% vs.4.6% vs.3.5% vs.5.7%,P=0.003).Kaplan-Meier survival analysis evidenced higher mortality rate in low weight group at 18 months after TAVR(log-rank P<0.01).Multivariate Cox regression analysis showed that the risk of long-term adverse cardiovascular events was significantly higher in low weight group than in normal weight group(HR=7.633,95%CI:1.012-57.564,P=0.049).Conclusions:Low weight patients with severe AS have a higher incidence of perioperative complications and a poor long-term prognosis.Such patients should appropriately strengthen their nutritional intake and adjust their body weight to normal levels before performing TAVR.