Cardiopulmonary exercise testing evaluates the efficacy of transcatheter aortic valve replacement in asymptomatic patients with severe aortic stenosis
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摘要: 目的 应用心肺运动试验评价经导管主动脉瓣置换(TAVR)术在无症状主动脉瓣重度狭窄患者中的疗效。 方法 回顾性分析在河北医科大学第一医院心脏中心住院行TAVR手术并完成3个月随访的无症状主动脉瓣重度狭窄患者28例。所有患者均完善术前检查，观察手术的安全性指标：瓣膜置入即刻成功率、瓣膜移位、死亡、心脏传导阻滞、瓣周漏、冠状动脉阻塞、脑卒中、入径血管破裂、心脏压塞、主动脉夹层、大出血；有效性指标：术前及术后1 d、7 d、3个月的脑钠肽(BNP)、心脏彩超情况；运动耐量指标：术前及术后3个月的心肺运动试验情况。通过上述指标评价TAVR疗效。 结果 ① TAVR手术安全性指标：瓣膜植入即刻成功率100%，发生瓣膜移位0例；新发束支阻滞1例(3.5%)，无症状；瓣周漏1例(3.5%)，且 < 2 mm。无脑卒中、入径血管破裂、大出血、死亡、冠状动脉阻塞、心脏压塞、主动脉夹层病例。②TAVR手术有效性指标：BNP、主动脉瓣最大跨瓣流速、主动脉瓣收缩期跨瓣压差、主动脉瓣平均跨瓣压差均较术前明显好转。③TAVR手术运动耐量指标：Weber心功能、峰值摄氧量、无氧阈、二氧化碳当量斜率、收缩压下降、ST-T改变均较术前明显改善。 结论 心肺运动试验可评价TAVR在无症状主动脉瓣重度狭窄患者中的疗效。
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关键词:
- 心肺运动试验 /
- 主动脉瓣重度狭窄 /
- 经导管主动脉瓣置换术
Abstract: Objective This study was to use cardiopulmonary exercise testing to evaluate the efficacy of transcatheter aortic valve replacement in asymptomatic patients with severe aortic stenosis. Methods Retrospective analysis of 28 asymptomatic patients with severe aortic stenosis who underwent TAVR surgery and completed a 3-month follow-up at the Heart Center of the First Hospital of Hebei Medical University. All patients underwent preoperative examination and preoperative cardiopulmonary exercise testing to observe the safety indicators of the surgery, including immediate success rate of valve implantation, valve displacement, death, heart conduction block, perivalve leakage, coronary occlusion, stroke, rupture of access vessels, cardiac tamponade, active aortic dissection, and massive bleeding. Effectiveness indicators: BNP and cardiac color Doppler ultrasound before and 1 day, 7 days, and 3 months after surgery. Exercise tolerance index: Cardiopulmonary exercise test results before and 3 months after surgery. Evaluate the efficacy of transcatheter aortic valve implantation using the above indicators. Results ① Safety index of TAVR surgery: immediate success rate of valve implantation was 100%, and valve displacement occurred in 0 cases; One case(3.5%) of new bundle branch block was asymptomatic. Perivalvular leakage was found in 1 case(3.5%) and < 2 mm. There were no cases of stroke, entrance vessel rupture, massive hemorrhage, death, coronary artery obstruction, cardiac tamponade, or aortic dissection. ② The effectiveness indicators of TAVR surgery: BNP, maximum cross-valve flow rate, systolic cross-valve pressure difference and mean cross-valve pressure difference were significantly improved compared with those before surgery. ③ Exercise tolerance indexes of TAVR surgery: Weber's heart function, peak oxygen uptake, anaerobic threshold, carbon dioxide equivalent slope, systolic blood pressure drop and ST-T changes were significantly improved compared with those before surgery. Conclusion Cardiopulmonary exercise test can evaluate the efficacy of TAVR in asymptomatic patients with severe aortic stenosis. -
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表 1 手术前后有效性指标
Table 1. Comparison of data
X±S 有效性指标 术前(28例) 术后1 d(28例) 术后7 d(28例) 术后3个月(28例) BNP/(pg/mL) 279.5±132.3 263.1±75.2 189.7±49.61) 164.8±49.51) 主动脉瓣最大跨瓣流速/(cm/s) 459.6±67.2 226.3±41.61) 219.5±40.21) 214.2±42.31) 主动脉瓣收缩期跨瓣压差/mmHg 85.8±26.9 21.7±6，11) 21.1±6.31) 20.9±4.91) 主动脉瓣平均跨瓣压差/mmHg 51.6±11.7 13.7±7.21) 12.5±6.91) 12.3±5.21) 左心室射血分数/% 57.7±15.6 59.2±9.3 59.6±8.7 59.3±10.8 左心室舒张末期内径/mm 46.8±11.2 45.9±12.1 43.7±10.7 41.5±9.4 与术前比较，1)P＜0.05。 
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表 2 手术前后心肺运动试验比较
Table 2. Comparison of cardiopulmonary exercise
例(%), X±S 心肺运动指标 术前(28例) 术后3个月(28例) F/t P Weber心功能分级 A 4(14.2) 14(50.0) 8.187 0.0091) B 7(25.0) 10(35.7) 0.760 0.562 C 16(57.1) 4(14.2) 11.200 0.0021) D 1(3.5) 0 1.018 1.000 峰值摄氧量/(mL/kg/min) 15.61±3.62 19.75±4.02 4.049 0.0011) 无氧阈/(mL/kg/min) 11.14±2.78 14.39±2.98 4.219 0.0011) 二氧化碳当量斜率 27.53±4.76 24.31±4.03 2.731 0.0081) 收缩压下降 9(32.1) 1(3.5) 7.791 0.0121) ST-T改变 11(39.2) 2(7.1) 8.114 0.0101) 与术前比较，1)P＜0.05。
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