摘要
目的分析应用国产自膨式瓣膜行经导管主动脉瓣置换术(TAVR)后严重传导损伤的相关因素并评估其预测效能。方法回顾性纳入2016年12月至2022年10月于中国人民解放军总医院第一医学中心应用国产自膨式主动脉瓣膜行TAVR患者。根据术后结果分为正常组和传导损伤组,采用logistic回归分析筛选相关因素。绘制受试者工作特征(ROC)曲线,计算预测效能并评估效能差异。采用SPSS 26.0软件进行数据分析。根据数据类型,组间比较分别采用t检验、U检验及χ^(2)检验。结果纳入患者84例,其中正常组60例,传导损伤组24例。2组间左室流出道(LVOT)面积、LVOT面积/瓣环面积、室间隔膜部长度、室间隔膜部长度和植入深度的差值(ΔMSID)比较,差异均有统计学意义(均P<0.05)。多因素logistic回归分析显示,LVOT面积/瓣环面积(OR=0.874,95%CI 0.797~0.959,P=0.004)、ΔMSID(OR=0.660,95%CI 0.515~0.846,P=0.001)是TAVR术后严重传导损伤的独立危险因素。ROC曲线示LVOT面积/瓣环面积、ΔMSID的曲线下面积分别为0.792、0.768,二者联合的曲线下面积为0.908,DeLong检验显示单因素与二者联合指标的预测差异有统计学意义(P<0.05)。结论LVOT面积/瓣环面积、ΔMSID是TAVR术后出现严重传导损伤的独立危险因素,可用于预测术后新发传导损伤的发生,二者联合较单因素预测效能更高。
Objective To analyze the factors associated with severe conduction injury after transcatheter aortic valve implantation(TAVR)with domestic self-expanding valves and assess their predictive efficacy.Methods A retrospective trial was conducted on the patients undergoing TAVR with domestic self-expanding aortic valves in the First Medical Center of Chinese PLA General Hospital from December 2016 to October 2022.According to their postoperative outcomes,they were divided into normal and conduction injury groups.Logistic regression analysis was used to screen the relevant factors.Receiver operating characteristic(ROC)curve was plotted to calculate their predicted efficacy and evaluate the difference in efficacy.SPSS statistics 26.0 was used for statistical analysis.Data comparison between two groups was performed using student′s t test,U test or Chi-square test depending on data type.Results There were 84 patients being enrolled,including 60 patients in the normal group and 24 patients in the conduction injury group.Significant differences were observed in following indicators between the two groups(P=0.005),including left ventricular outflow tract(LVOT)area,LVOT area/annular area,septal length,and difference between septal length and implantation depth(membranous septum minus implantation depth,ΔMSID).Multivariate logistic regression analysis showed that LVOT area/annular area(OR=0.874,95%CI 0.797-0.959,P=0.004)andΔMSID(OR=0.660,95%CI 0.515-0.846,P=0.001)were independent risk factors for severe conduction injury after TAVR.ROC curve analysis indicated that the area under the curve of LVOT area/annular area andΔMSID was 0.792 and 0.768,respectively,and was 0.908 for their combination.DeLong test revealed that statistical significance was seen in the predictive efficacy of the single indicator vs their combination(P<0.05).Conclusion LVOT area/annular area andΔMSID are independent risk factors for incidence of severe conduction injury after TAVR,and can be used to predict the occurrence of new conduction injury af
作者
孙泽瑜
单冬凯
王晶
蒋博
辛然
陈韵岱
刘长福
Sun Zeyu;Shan Dongkai;Wang Jing;Jiang Bo;Xin Ran;Chen Yundai;Liu Changfu(Department of Cardiology,First Medical Center,Chinese PLA General Hospital,Beijing 100853,China;School of Medicine,Nankai University,Tianjin 300071,China;Chinese PLA Medical School,Beijing 100853,China)
出处
《中华老年多器官疾病杂志》
2023年第8期591-597,共7页
Chinese Journal of Multiple Organ Diseases in the Elderly
基金
军委后勤保障部面上项目(21BZ33)。
关键词
经导管主动脉瓣置换术
左束支传导阻滞
永久起搏器植入
主动脉瓣膜
transcatheter aortic valve implantation
left bundle branch block
permanent pacemaker implantation
aortic valve
