Transkateter aort kapak implantasyonu sonrasında sol ventrikül yeniden şekillenme paternlerinin ters yeniden şekillenme ve klinik sonuçlar üzerindeki etkisi

Yıl 2025, Cilt: 8 Sayı: 5, 839 - 846, 16.09.2025

Murat Can Güney

https://doi.org/10.32322/jhsm.1746396

Öz

Amaç: Bu çalışmada, transkateter aort kapak implantasyonu (TAVI) uygulanan hastalarda işlem öncesi sol ventrikül (LV) yeniden şekillenme (remodelling) fenotiplerinin klinik ve ekokardiyografik sonuçlar üzerindeki etkisi değerlendirildi.

Yöntem: Üç merkezden, Temmuz 2011 ile Ocak 2024 tarihleri arasında TAVI uygulanan ve yeterli ekokardiyografik verisi bulunan toplam 413 hasta retrospektif olarak incelendi. Hastalar; konsantrik yeniden şekillenme (CR, %7), konsantrik hipertrofi (CH, %84.5) ve eksantrik hipertrofi (EH, %8.5) olmak üzere üç gruba ayrıldı.

Bulgular: EH grubundaki hastalar daha genç (ortalama yaş: 76, p<0.001) ve erkek oranı daha yüksekti (p<0.001). Bu grupta MI (p<0.001) ve CABG öyküsü (p=0.003) daha sık görüldü. EH grubunda bazal EF en düşük (p<0.001), LVEDD ve LVESD en yüksek (her ikisi için p<0.001), LFLG prevalansı daha fazla (p<0.001) ve VSAS daha azdı (p=0.005). TAVI sonrası birinci yılda EF artışı EH grubunda %17.6 (p=0.002), LVEDD azalması ise %7.3 olarak gözlendi (p=0.006). Ayrıca EH grubunda kalıcı pacemaker oranı %28.6 olup CH grubuna kıyasla anlamlı olarak daha yüksekti (p=0.022). Gruplar arasında hastane içi ve 1 yıllık mortalite açısından fark gözlenmedi (p>0.05).

Sonuç: LV yeniden şekillenme paternleri, TAVI sonrası reverse remodelling ve pacemaker gereksinimi ile yakından ilişkilidir. Özellikle EH grubunda yapısal iyileşme daha belirgin olsa da iletim sistemi komplikasyonları daha sık izlenmektedir.

Anahtar Kelimeler

Transkateter aort kapak implantasyonu , Sol ventrikül yeniden şekillenme , Konsantrik hipertrofi , Eksantrik hipertrofi , Ekokardiyografi , Ters yeniden şekillenme , Kalıcı pacemaker , Aort darlığı

Prognostic value of left ventricular remodelling phenotypes in patients undergoing transcatheter aortic valve implantation

Öz

Aims: This study aimed to evaluate the impact of baseline left ventricular (LV) remodeling phenotypes on clinical and echocardiographic outcomes in patients undergoing transcatheter aortic valve implantation (TAVI).
Methods: A total of 413 patients with aortic stenosis (AS) who underwent TAVI between July 2011 and January 2024 were retrospectively analyzed. Based on echocardiographic parameters, patients were classified into concentric remodeling (CR, 7%), concentric hypertrophy (CH, 84.5%), and eccentric hypertrophy (EH, 8.5%) groups.
Results: Patients in the EH group were significantly younger (mean age: 76, p<0.001) and predominantly male (p<0.001). Prior myocardial infarction (MI) (p<0.001) and coronary artery bypass grefting (CABG) (p=0.003) were more common in this group. EH patients had the lowest baseline ejection fraction (EF) (p<0.001), highest left ventricular end diastolic dimension (LVEDD) and left ventricular end systolic dimension (LVESD) (both p<0.001), increased prevalence of low flow low gradient (LFLG) AS (p<0.001), and lower frequency of very severe aortic stenosis (VSAS) (p=0.005). At one-year follow-up, EH patients showed the most pronounced improvement in EF (+17.6%, p=0.002) and reduction in LVEDD (-7.3%, p=0.006). Permanent pacemaker implantation was highest in the EH group (28.6%) and significantly greater than in the CH group (p=0.022). No significant differences in in-hospital or one-year mortality were observed between groups (p>0.05).
Conclusion: LV remodeling patterns are strongly associated with reverse remodeling and conduction-related complications after TAVI. While EH patients show greater structural recovery, they are also at higher risk for post-procedural pacemaker implantation.

Anahtar Kelimeler

Transcatheter aortic valve implantation , left ventricular remodeling , concentric hypertrophy , eccentric hypertrophy , permanent pacemaker , aortic stenosis

Kaynakça

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