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

作者：Fairbairn Timothy A; Steadman Christopher D; Mather Adam N; Motwani Manish; Blackman Daniel J; Plein Sven; McCann Gerry P; Greenwood John P^*

来源：Heart, 2013, 99(16): 1185-1191.

DOI：10.1136/heartjnl-2013-303927

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. %26lt;br%26gt;Design A 1.5 T CMR scan was performed preoperatively and 6 months postoperatively. %26lt;br%26gt;Setting University hospitals of Leeds and Leicester, UK. %26lt;br%26gt;Patients 50 (25 TAVI, 25 SAVR; age 77 +/- 8 years) highrisk severe symptomatic aortic stenosis (AS) patients. %26lt;br%26gt;Main outcome measures Valve haemodynamics, ventricular volumes, ejection fraction (EF), mass and ME. %26lt;br%26gt;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%26lt;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%26lt;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%26lt;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%26lt;0.01) and baseline ventricular volumes (p%26lt;0.001) were the major predictors of reverse remodelling. %26lt;br%26gt;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.

• 出版日期2013-8-15