主动脉瓣狭窄合并肺动脉高压患者经导管主动脉瓣植入术后肺动脉压力改善的影响因素分析

Analysis of the influencing factors of pulmonary artery pressure improvement after transcatheter aortic valve implantation in patients with aortic stenosis and pulmonary hypertension

目的探讨主动脉瓣狭窄(AS)合并肺动脉高压(PAH)患者经导管主动脉瓣植入术(TAVI)后肺动脉高压(PAH)改善情况及相关影响因素分析。方法回顾性分析2022年1月至2023年12月在首都医科大学附属北京安贞医院接受TAVI术且合并PAH的AS患者168例,根据术后1个月肺动脉压力情况分为PAH改善组和PAH未改善组。比较2组术前一般资料及超声心动图参数,分析术后PAH改善的影响因素。结果168例患者中有123例患者(73.2%)术后PAH改善(PAH改善组),45例患者(26.8%)术后PAH未改善(PAH未改善组)。2组患者合并心房颤动比例、左心房内径(LAD)、左心室舒张末期内径、左心室舒张末期容积、左心室收缩末期容积、合并中或重度三尖瓣反流(TR)比例比较差异均有统计学意义(均P<0.05)。多因素Logistic回归分析结果显示,心房颤动(比值比=0.444,95%置信区间:0.201~0.981,P=0.045)、LAD(比值比=1.086,95%置信区间:1.008~1.169,P=0.029)、合并中或重度TR(比值比=0.428,95%置信区间:0.189~0.967,P=0.041)均是TAVI术后PAH改善的独立影响因素。结论TAVI可以有效改善AS合并PAH患者的PAH程度,术前合并心房颤动、术前LAD及合并中或重度TR是术后PAH改善的影响因素。

Objective To investigate the improvement of pulmonary arterial hypertension(PAH)in patients with aortic stenosis(AS)and PAH after transcatheter aortic valve implantation(TAVI)and analyze the related factors.Methods A total of 168 AS patients with PAH undergoing TAVI in Beijing Anzhen Hospital,Capital Medical University from January 2022 to December 2023 were retrospectively analyzed.According to the pulmonary artery pressure 1 month after surgery,the patients were divided into PAH improvement group and PAH non-improvement group.The preoperative general data and echocardiographic parameters of the two groups were compared,and the influencing factors of the improvement of PAH after operation were analyzed.Results Among 168 patients,123 patients(73.2%)had improvement in PAH after surgery(PAH improvement group),and 45 patients(26.8%)did not improve(PAH non-improvement group).There were significant differences in atrial fibrillation,left atrial diameter(LAD),left ventricular end-diastolic diameter,left ventricular end-diastolic volume,left ventricular end-systolic volume,and moderate or severe tricuspid regurgitation(TR)between the two groups(all P<0.05).Multivariate Logistic regression analysis showed that atrial fibrillation(odds ratio=0.444,95%confidence interval:0.201-0.981,P=0.045),LAD(odds ratio=1.086,95%confidence interval:1.008-1.169,P=0.029),combined with moderate or severe TR(odds ratio=0.428,95%confidence interval:0.189-0.967,P=0.041)were independent influencing factors for the improvement of PAH after TAVI.Conclusions TAVI can effectively improve the degree of PAH in AS patients with PAH.Preoperative atrial fibrillation,preoperative LAD and moderate or severe TR are the influencing factors for the improvement of PAH after TAVI.