Transkateter aort kapak implantasyonu uygulanan hastalarda anormal spirometrinin klinik önemi ve geri dönüşümlülüğü

Öz

Amaç: Transkateter aort kapak implantasyonu (TAVI) uygulanacak ciddi aort darlığı hastalarında, işlem öncesi spirometride saptanan anormallikler sık görülmektedir. Ancak bu bulgular gerçek kronik akciğer hastalığından ziyade hemodinamik kökenli pulmoner konjesyonu yansıtabilir. Bu çalışmada, bilinen pulmoner hastalığı olmayan TAVI hastalarında anormal spirometrinin sıklığı, klinik önemi ve geri dönüşümlülüğü değerlendirilmiştir. Gereç ve Yöntemler: Bu prospektif gözlemsel çalışmaya 2020–2026 yılları arasında TAVI uygulanan ciddi aort darlığı hastaları dahil edildi. Bilinen kronik pulmoner hastalığı veya atriyal fibrilasyonu olan hastalar dışlandı. Başlangıç spirometri sonuçlarına göre hastalar normal ve anormal solunum fonksiyon testi (SFT) gruplarına ayrıldı. Hastane yatış süresi ve mortalite gibi klinik sonlanımlar gruplar arasında karşılaştırıldı. Başlangıçta anormal SFT saptanan hastalarda 3. ayda kontrol spirometrisi yapılarak değişim değerlendirildi. Bulgular: Toplam 69 hasta çalışmaya dahil edildi; bunların 30’unda (%43,5) başlangıçta anormal spirometri saptandı ve bu hastaların çoğunda PRISm patern mevcuttu (%73,3). Normal ve anormal SFT grupları arasında hastane yatış süresi, hastane içi komplikasyonlar ve takip mortalitesi açısından anlamlı fark saptanmadı. Anormal başlangıç spirometrisi olan hastalarda takipte FEV₁ ve FVC değerlerinde anlamlı artış izlendi (her ikisi için p<0,001) ve hastaların %65,5’inde en az bir derece fonksiyonel iyileşme gözlendi. Sonuç: Bilinen pulmoner hastalığı olmayan TAVI hastalarında anormal spirometri bulguları sık görülmekte olup kısa dönem klinik sonuçlarla ilişkili değildir ve büyük ölçüde geri dönüşümlüdür. Bu bulgular, spirometrik anormalliklerin yapısal akciğer hastalığından ziyade hemodinamik mekanizmalarla ilişkili olabileceğini düşündürmektedir.

Anahtar Kelimeler

• Akciğer hastalığı
• Aort darlığı
• Solunum fonksiyon testi
• TAVİ

Etik Beyan

Çalışma, Bakırçay Üniversitesi Etik Kurulu tarafından onaylanmıştır (tarih: 10 Eylül 2025, numara: 2469).

Clinical significance and reversibility of abnormal spirometry in patients undergoing transcatheter aortic valve implantation

Öz

Aim: Abnormal spirometry is frequently observed during pre-procedural evaluation of patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI). However, such findings may reflect hemodynamically mediated pulmonary congestion rather than true chronic pulmonary disease. To evaluate the prevalence, clinical significance, and reversibility of abnormal spirometry in patients with severe aortic stenosis undergoing TAVI without established pulmonary disease. Material and Methods: This prospective observational study included patients with severe aortic stenosis who underwent TAVI between 2020 and 2026. Patients with known chronic pulmonary disease or atrial fibrillation were excluded. Based on baseline spirometry, patients were classified as having normal or abnormal pulmonary function. Clinical outcomes, including length of hospital stay and mortality, were compared between groups. Follow-up spirometry was performed in patients with abnormal baseline findings to assess reversibility. Results: Among 69 included patients, 30 (43.5%) had abnormal baseline spirometry, predominantly PRISm patterns (73.3%). Length of hospital stay and in-hospital or follow-up outcomes were similar between patients with normal and abnormal spirometry. At follow-up, patients with abnormal baseline spirometry demonstrated significant improvement in forced expiratory volume in one second and forced vital capacity (both p<0.001), with at least one-class improvement observed in 65.5% of patients. Conclusion: In patients undergoing TAVI without known pulmonary disease, abnormal spirometry is common but not associated with adverse short-term outcomes and appears largely reversible, suggesting a hemodynamic rather than structural pulmonary mechanism.

Anahtar Kelimeler

• Aortic stenosis
• interventional cardiology
• Pulmonary function test
• TAVI

Etik Beyan

The study was approved by the Bakırçay University Ethics Committee (date: 10.09.2025 , number: 2469).

Kaynakça

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