Effect Of TAVR On Cardiac Function In Patients With Aortic Stenosis And Analysis Of Risk Factors Of New-onset Heart Block After TAVR

PartⅠEffect of TAVR on cardiac function in patients with aortic stenosisObjective Our study mainly analyzed the changes in cardiac structure,cardiac function,valve hemodynamics,and the occurrence of adverse events related to transcatheter aortic valve replacement（TAVR）in patients with severe aortic stenosis（AS）with three types of heart failure（HF）after undergoing TAVR,to explore its effectiveness and safety in such patients.Methods Patients with severe AS with HF who received TAVR at Yantai Yuhuangding Hospital Affiliated to Qingdao University from september 2017 to september 2022 were included.TAVR cases were stratified into three groups[heart failure with reduced ejection fraction（LVEF≤40%,HFrEF）,heart failure with mildly reduced ejection fraction（41%≤LVEF≤49%,HFmr EF）,heart failure with preserved ejection fraction（LVEF≥50%,HFp EF）]by left ventricular ejection fraction（LVEF）.Baseline clinical data,echocardiographic indexes before and 1 week,1 month and 6 months after TAVR,B-type natriuretic peptide（BNP）at 1 month after TAVR and NYHA class at 6 months after TAVR were collected.Baseline characteristics,changes in echocardiographic parameters（1 week,1 month and 6 months）,BNP（1 month）,and NYHA class（6 months）post-TAVR were compared across the three groups.Meanwhile,we observed and analyzed the adverse events of the patients after TAVR.Results1.Preoperative clinical datasA total of 96 patients were included.Amongst these,66 patients were classified as HFp EF,15 as HFmr EF and 15 as HFrEF.The mean age of the groups decreased with increasing severity of EF reduction（P<0.05）.Compared to patients with HFp EF,high-sensitivity Troponin I（hs Tn I）,B-type natriuretic peptide（BNP）,and NYHA class at baseline was significantly higher in patients with HFrEF（P<0.05）.Besides,compared to patients with HFp EF,hs Tn I and BNP was significantly higher in patients with HFmr EF（P<0.05）.Compared with HFp EF group,left atrium anteroposterior diameter（LAAD）and left ventricular end-diastolic dimension（LVEDD）in HFrEF and HFmr EF groups were larger（P<0.05）.Compared with HFmr EF group,LVEDD in HFrEF group was larger（P<0.05）.The preoperative usage rates of sacubitril valsartan sodium tablets,torsemide,spironolactone and levosimendan in patients with HFrEF and HFmr EF were significantly higher than those in patients with HFp EF（P<0.05）.2.Effectiveness of TAVR1 week:Compared with baseline,LVEF of the HFmr EF and HFrEF groups increased significantly 1 week post-TAVR（P<0.05）.Aortic valve peak gradient（AVPG）and Peak aortic velocity(V_max)decreased significantly in the three groups compared with baseline（P<0.05）.And pulmonary artery systolic pressure（PASP）in patients with HFp EF and HFrEF decreased significantly compared with baseline（P<0.05）.Compared to HFp EF group,HFmr EF and HFrEF patients showed significant improvements in LVEF（P<0.05）.1 month:LAAD,LVEDD,AVPG,PASP and V_max in patients with HFrEF and HFp EF decreased significantly compared with baseline（P<0.05）.AVPG,PASP and V_maxin patients with HFmr EF also decreased significantly（P<0.05）.And LVEF increased significantly in three groups compared with baseline（P<0.05）.Compared to HFp EF group,HFmr EF and HFrEF patients showed more significant improvements in LVEF（P<0.05）.Compared with HFp EF and HFmr EF groups,PASP in HFrEF group decreased more significantly（P<0.05）.Compared with the HFp EF group,the BNP levels in the HFmr EF and HFrEF groups decreased more significantly（P<0.05）.6 months:LVEDD,AVPG,PASP and V_max in patients with HFrEF decreased significantly compared with baseline（P<0.05）.LVEDD,AVPG,PASP and V_max in patients with HFmr EF also decreased significantly（P<0.05）.LAAD,LVEDD,AVPG,PASP and V_max in patients with HFp EF decreased significantly（P<0.05）.Compared to HFp EF group,HFmr EF and HFrEF patients showed significant improvements in LVEF（P<0.05）.Compared with HFp EF and HFmr EF groups,PASP in HFrEF group decreased more significantly（P<0.05）.The majority of patients experienced an improvement at least one NYHA class in all three groups six months post-TAVR.3.Safety of TAVRThe risk of short-term adverse events in patients with HFrEF seemed to be comparable to those in patients with HFmr EF and HFp EF.Conclusions（1）TAVR can rapidly improve the clinical symptoms of the three HF classes,significantly improve left ventricular（LV）function,LV structure,and hemodynamics,and improve short-term clinical prognosis.（2）Patients with HFrEF undergoing TAVR demonstrate a more significant improvement in LV function compared to those with HFmr EF and HFp EF.（3）The risk of short-term adverse events in patients with HFrEF seems to be comparable to those in patients with HFmr EF and HFp EF.PartⅡ Risk factors of new-onset heart block after TAVR in patients with aortic stenosisObjective To investigate the occurrence and risk factors of new-onset heart block after TAVR in patients with severe aortic stenosis（AS）with heart failure（HF）.Methods This study included 75 patients with severe AS with HF who underwent TAVR at Yantai Yuhuangding Hospital Affiliated to Qingdao University from september 2017 to september 2022.The patients were divided into 2 groups according to whether there was new-onset heart block or not after TAVR.The basic clinical characteristics,cardiac structural parameters,surgical features and ECG parameters were compared between the two groups.And the factors with P<0.05 were analyzed by multifactor logistic regression.Results Totally 75 patients were included in the study.26 patients developed new-onset heart block after TAVR,including 8 patients with third-degree atrioventricular block,15patients with left bundle branch block（1 of these had concurrent First-degree atrioventricular block）,and 3 patients with right bundle branch block.Multivariate logistic analysis showed that preoperative high-level low density lipoprotein cholesterol（LDL-C）[OR 2.732,95%CI（1.232,6.054）,P=0.013]and△QRS interval[OR 1.053,95%CI（1.029,1.079）,P<0.001]were independent risk factors for heart block after TAVR.Conclusions Heart block is the common complication of TAVR.High-level LDL-C and△QRS interval are independent risk factors for new-onset heart block after TAVR.