PMID- 35545323
OWN - NLM
STAT- MEDLINE
DCOM- 20220516
LR  - 20240321
IS  - 1672-7347 (Print)
IS  - 1672-7347 (Linking)
VI  - 47
IP  - 3
DP  - 2022 Mar 28
TI  - Clinical characteristics of severe aortic stenosis patients combined with 
      diabetes mellitus after transcatheter aortic valve replacement and short-term 
      outcome.
PG  - 309-318
LID - 1672-7347(2022)03-0309-10 [pii]
LID - 10.11817/j.issn.1672-7347.2022.210357 [doi]
AB  - OBJECTIVES: Type 2 diabetes (T2DM) is a common comorbidity in patients with 
      degenerative aortic stenosis (AS).As a key item of the American Society of 
      Thoracic Surgeons (STS) score, it has a vital impact on the clinical prognosis of 
      traditional thoracic surgery. T2DM has an adverse effect on the morbidity and 
      mortality of cardiovascular diseases. At the same time, studies have shown that 
      T2DM are associated with myocardial hypertrophy and remodeling, decreased left 
      ventricular function, and worsening heart failure symptoms in the AS patients. 
      Transcatheter aortic valve replacement (TAVR) as an interventional method to 
      replace the aortic valve has better safety for middle and high risk patients in 
      surgery, but the impact of T2DM on the clinical outcome of TAVR in AS patients is 
      not clear.By analyzing the clinical and image characteristics of patients with AS 
      and T2DM who received TAVR treatment, so as to explore the effect of T2DM on the 
      perioperative complications and prognosis of TAVR. METHODS: A total of 100 
      consecutive patients with severe AS, who underwent TAVR treatment and were 
      followed up for more than 1 month, were selectedin the Second Xiangya Hospital of 
      Central South University from January 2016 to December 2020.Among them, 5 
      patients who were treated with TAVR due to simple severe aortic regurgitation 
      were not included, therefore a total of 95 patients with severe aortic stenosis 
      were enrolled in this study.The age of the patients was (72.7+/-4.8) years old, and 
      there were 58 males (61.1%), and the patients with moderate or above aortic 
      regurgitation had 30 cases (31.6%). The patients were divided into a diabetic 
      group and a non-diabetic group according to whether they were combined with 
      T2DM.There was no statistical difference in age, gender, body mass index (BMI), 
      STS score, and New York Heart Association (NYHA) cardiac function classification 
      between the 2 groups (all P>0.05). The primary end point was defined as a 
      composite event consisting of all-cause death and stroke one month after surgery, 
      and the secondary end point was defined as TAVR-related complications immediately 
      after surgery and one month after surgery.The preoperative clinical data, cardiac 
      ultrasound data, CT data, postoperative medication and the incidence of each 
      endpoint event were compared between the 2 groups.The predictive model of adverse 
      events was constructed by single factor and multivariate logistic regression. 
      RESULTS: Compared with the non-diabetic group, the diabetic group had high blood 
      pressure and chronic renal insufficiency.There was no significant difference in 
      preoperative ultrasound echocardiography between the 2 groups. Preoperative CT 
      evaluation found that the anatomical structure of the aortic root in the diabetic 
      group was smaller than that in the non-diabetic group, and there was no 
      significant difference in the incidence of bicuspid aortic valve between the 2 
      groups (all P<0.05). In terms of postoperative medication, the use of statins in 
      the diabetes group was significantly higher than that in the non-diabetic group. 
      In the diabetes group, 6 patients (37.5%) received insulin therapy, and 9 
      patients (56.3%) received oral medication alone.Univariate logistic regression 
      analysis showed that the all-cause death and stroke compound events was increased 
      in the diabetes group in 30 days after TAVR (OR=6.86; 95% CI: 2.14 to 21.79; 
      P<0.01). Heart disease (OR=2.80; 95% CI: 0.99 to 7.88; P<0.05) and chronic renal 
      insufficiency (OR=3.75; 95% CI: 1.24 to 11.34; P<0.05) were also risk factors for 
      all-cause death and stroke compound events.In a multivariate analysis, after 
      adjusting for age, gender, BMI, comorbidities, N-terminal pro-B type natriuretic 
      peptide (NT-proBNP), total calcification score, ejection fraction, and degree of 
      aortic regurgitation, T2DM was still a risk factor for all-cause death and stroke 
      compound events in 30 days after TAVR (OR=12.68; 95% CI: 1.76 to 91.41; P<0.05). 
      CONCLUSIONS: T2DM is a risk factor for short-term poor prognosis in patients with 
      symptomatic severe AS after TAVR treatment. T2DM should play an important role in 
      the future construction of the TAVR surgical risk assessment system, but the 
      conclusions still need to be further verified by long-term follow-up of 
      large-scale clinical studies.
FAU - Su, Wen
AU  - Su W
AD  - Department of Cardiovascular Medicine, Second Xiangya Hospital, Central South 
      University, Changsha 410011, China. dr_suwen@163.com.
FAU - Tai, Shi
AU  - Tai S
AD  - Department of Cardiovascular Medicine, Second Xiangya Hospital, Central South 
      University, Changsha 410011, China.
FAU - Huang, Yiyuan
AU  - Huang Y
AD  - Department of Cardiovascular Medicine, Second Xiangya Hospital, Central South 
      University, Changsha 410011, China.
FAU - Hu, Xinqun
AU  - Hu X
AD  - Department of Cardiovascular Medicine, Second Xiangya Hospital, Central South 
      University, Changsha 410011, China.
FAU - Zhou, Shenghua
AU  - Zhou S
AD  - Department of Cardiovascular Medicine, Second Xiangya Hospital, Central South 
      University, Changsha 410011, China.
FAU - Fang, Zhenfei
AU  - Fang Z
AD  - Department of Cardiovascular Medicine, Second Xiangya Hospital, Central South 
      University, Changsha 410011, China. fangzhenfei@csu.edu.cn.
LA  - eng
LA  - chi
GR  - 81801394/the National Natural Science Foundation/
GR  - 2021SK2004/the Key Field Research and Development Plan of Hunan Provincial 
      Department of Science and Technology/
PT  - Journal Article
TT  - 经导管主动脉瓣置换术后重度主动脉瓣狭窄患者合并糖尿病的临床特征及其短期预后.
PL  - China
TA  - Zhong Nan Da Xue Xue Bao Yi Xue Ban
JT  - Zhong nan da xue xue bao. Yi xue ban = Journal of Central South University. 
      Medical sciences
JID - 101230586
SB  - IM
MH  - Aged
MH  - Aortic Valve/surgery
MH  - *Aortic Valve Insufficiency/etiology/surgery
MH  - *Aortic Valve Stenosis/surgery
MH  - *Diabetes Mellitus, Type 2/complications
MH  - Female
MH  - Humans
MH  - Male
MH  - *Renal Insufficiency, Chronic/complications
MH  - Risk Factors
MH  - Severity of Illness Index
MH  - *Stroke
MH  - *Transcatheter Aortic Valve Replacement/adverse effects/methods
MH  - Treatment Outcome
MH  - United States
PMC - PMC10930055
OAB - OBJECTIVE: Type 2 diabetes (T2DM) is a common comorbidity in patients with 
      degenerative aortic stenosis (AS).As a key item of the American Society of 
      Thoracic Surgeons (STS) score, it has a vital impact on the clinical prognosis of 
      traditional thoracic surgery. T2DM has an adverse effect on the morbidity and 
      mortality of cardiovascular diseases. At the same time, studies have shown that 
      T2DM are associated with myocardial hypertrophy and remodeling, decreased left 
      ventricular function, and worsening heart failure symptoms in the AS patients. 
      Transcatheter aortic valve replacement (TAVR) as an interventional method to 
      replace the aortic valve has better safety for middle and high risk patients in 
      surgery, but the impact of T2DM on the clinical outcome of TAVR in AS patients is 
      not clear.By analyzing the clinical and image characteristics of patients with AS 
      and T2DM who received TAVR treatment, so as to explore the effect of T2DM on the 
      perioperative complications and prognosis of TAVR. METHODS: A total of 100 
      consecutive patients with severe AS, who underwent TAVR treatment and were 
      followed up for more than 1 month, were selectedin the Second Xiangya Hospital of 
      Central South University from January 2016 to December 2020.Among them, 5 
      patients who were treated with TAVR due to simple severe aortic regurgitation 
      were not included, therefore a total of 95 patients with severe aortic stenosis 
      were enrolled in this study.The age of the patients was (72.7+/-4.8) years old, and 
      there were 58 males (61.1%), and the patients with moderate or above aortic 
      regurgitation had 30 cases (31.6%). The patients were divided into a diabetic 
      group and a non-diabetic group according to whether they were combined with 
      T2DM.There was no statistical difference in age, gender, body mass index (BMI), 
      STS score, and New York Heart Association (NYHA) cardiac function classification 
      between the 2 groups (all P>0.05). The primary end point was defined as a 
      composite event consisting of all-cause death and stroke one month after surgery, 
      and the secondary end point was defined as TAVR-related complications immediately 
      after surgery and one month after surgery.The preoperative clinical data, cardiac 
      ultrasound data, CT data, postoperative medication and the incidence of each 
      endpoint event were compared between the 2 groups.The predictive model of adverse 
      events was constructed by single factor and multivariate logistic regression. 
      RESULTS: Compared with the non-diabetic group, the diabetic group had high blood 
      pressure and chronic renal insufficiency.There was no significant difference in 
      preoperative ultrasound echocardiography between the 2 groups. Preoperative CT 
      evaluation found that the anatomical structure of the aortic root in the diabetic 
      group was smaller than that in the non-diabetic group, and there was no 
      significant difference in the incidence of bicuspid aortic valve between the 2 
      groups (all P<0.05). In terms of postoperative medication, the use of statins in 
      the diabetes group was significantly higher than that in the non-diabetic group. 
      In the diabetes group, 6 patients (37.5%) received insulin therapy, and 9 
      patients (56.3%) received oral medication alone.Univariate logistic regression 
      analysis showed that the all-cause death and stroke compound events was increased 
      in the diabetes group in 30 days after TAVR (OR=6.86; 95% CI: 2.14 to 21.79; 
      P<0.01). Heart disease (OR=2.80; 95% CI: 0.99 to 7.88; P<0.05) and chronic renal 
      insufficiency (OR=3.75; 95% CI: 1.24 to 11.34; P<0.05) were also risk factors for 
      all-cause death and stroke compound events.In a multivariate analysis, after 
      adjusting for age, gender, BMI, comorbidities, N-terminal pro-B type natriuretic 
      peptide (NT-proBNP), total calcification score, ejection fraction, and degree of 
      aortic regurgitation, T2DM was still a risk factor for all-cause death and stroke 
      compound events in 30 days after TAVR (OR=12.68; 95% CI: 1.76 to 91.41; P<0.05). 
      CONCLUSION: T2DM is a risk factor for short-term poor prognosis in patients with 
      symptomatic severe AS after TAVR treatment. T2DM should play an important role in 
      the future construction of the TAVR surgical risk assessment system, but the 
      conclusions still need to be further verified by long-term follow-up of 
      large-scale clinical studies.
OABL- eng
OTO - NOTNLM
OT  - aortic valve stenosis
OT  - transcatheter aortic valve replacement
OT  - type 2 diabetes mellitus
COIS- 作者声称无任何利益冲突。
EDAT- 2022/05/12 06:00
MHDA- 2022/05/17 06:00
PMCR- 2022/03/28
CRDT- 2022/05/11 21:12
PHST- 2022/05/11 21:12 [entrez]
PHST- 2022/05/12 06:00 [pubmed]
PHST- 2022/05/17 06:00 [medline]
PHST- 2022/03/28 00:00 [pmc-release]
AID - 1672-7347(2022)03-0309-10 [pii]
AID - 10.11817/j.issn.1672-7347.2022.210357 [doi]
PST - ppublish
SO  - Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2022 Mar 28;47(3):309-318. doi: 
      10.11817/j.issn.1672-7347.2022.210357.