Background
Methods
Study population
Echocardiography examination
BAV procedures
Statistical analysis
Results
Patients’ clinical and baseline characteristics
Variables | All (n = 83) | MR group (n = 40) | Non-MR group (n = 43) | P value |
---|---|---|---|---|
Clinical data | ||||
Age, years | 86.2 ± 5.4 | 86.1 ± 6.5 | 86.4 ± 4.1 | 0.819 |
Female, n (%) | 56 (67.5) | 25 (62.5) | 31 (72.1) | 0.482 |
Body surface area, m2 | 1.4 ± 0.2 | 1.4 ± 0.2 | 1.4 ± 0.2 | 0.821 |
Body mass index, kg/m2 | 21.0 ± 3.4 | 20.8 ± 3.6 | 21.2 ± 3.3 | 0.623 |
NYHA III/IV, n (%) | 47 (60.2) | 28 (70.0) | 19 (44.2) | 0.094 |
STS score, % | 9.6 ± 6.9 | 11.1 ± 7.5 | 8.2 ± 6.0 | 0.051 |
Comorbidities,n(%) | ||||
Hypertension | 63 (75.9) | 29 (72.5) | 34 (79.1) | 0.609 |
Diabetes mellitus | 24 (28.9) | 13 (32.5) | 11 (25.6) | 0.629 |
Dyslipidemia | 31 (37.3) | 12 (30.0) | 19 (44.2) | 0.256 |
History of smoking | 11 (13.3) | 5 (12.5) | 6 (14.0) | 1.000 |
Coronary artery diseases | 13 (15.7) | 8 (20.0) | 5 (11.6) | 0.371 |
Peripheral arterial diseases | 8 (9.6) | 5 (12.5) | 3 (7.0) | 0.473 |
Cerebrovascular diseases | 11 (13.3) | 7 (17.5) | 4 (9.3) | 0.340 |
Atrial fibrillation | 26 (31.3) | 17 (42.5) | 9 (20.9) | 0.057 |
Approach for BAV,n(%) | ||||
Antegrade BAV | 65 (78.3) | 29 (72.5) | 36 (83.7) | 0.288 |
Previous BAV | 12 (14.5) | 5 (12.5) | 7 (16.3) | 0.758 |
Laboratory data | ||||
Hemoglobin, g/dL | 11.0 ± 1.7 | 10.5 ± 1.7 | 11.6 ± 1.6 | 0.004 |
Albumin, g/dL | 3.4 ± 0.5 | 3.2 ± 0.5 | 3.5 ± 0.5 | 0.010 |
Creatinine, mg/dL | 1.0 (0.8–1.2) | 1.1 (0.9–1.5) | 0.9 (0.7–1.0) | 0.002 |
eGFR, mL/min/1.73 m2 | 45.1 ± 20.3 | 39.4 ± 19.0 | 50.4 ± 20.1 | 0.012 |
BNP, pg/mL | 377 (167–758) | 702 (391–1042) | 216 (112–422) | < 0.001 |
Medications,n(%) | ||||
β-blocker | 52 (62.7) | 26 (65.0) | 26 (60.5) | 0.821 |
ACEI/ARB | 57 (68.7) | 26 (65.0) | 31 (72.1) | 0.636 |
Statin | 33 (39.8) | 12 (30.0) | 21 (48.8) | 0.116 |
CCB | 34 (41.0) | 9 (22.5) | 25 (58.1) | 0.002 |
Loop diuretics | 48 (57.8) | 25 (62.5) | 23 (53.5) | 0.506 |
MRA | 22 (26.5) | 11 (27.5) | 11 (25.6) | 1.000 |
Tolvaptan | 6 (7.2) | 5 (12.5) | 1 (2.3) | 0.101 |
Anticoagulant | 15 (18.1) | 8 (20.0) | 7 (16.3) | 0.778 |
Antiplatelet | 22 (26.5) | 11 (27.5) | 11 (25.6) | 1.000 |
Echocardiography parameters | ||||
Conventional parameters | ||||
LVEDD, mm | 44.6 ± 6.7 | 46.2 ± 6.0 | 43.2 ± 7.1 | 0.039 |
LVESV, mm | 30.7 ± 7.1 | 32.6 ± 6.8 | 28.9 ± 7.0 | 0.018 |
LVEF, % | 55.2 ± 11.2 | 51.4 ± 13.0 | 58.6 ± 7.8 | 0.003 |
LVSVI, mL | 41.6 ± 12.9 | 38.3 ± 11.7 | 44.7 ± 13.2 | 0.023 |
IVST, mm | 10.8 ± 2.3 | 10.7 ± 2.1 | 10.9 ± 2.4 | 0.574 |
PWT, mm | 10.5 ± 2.1 | 10.5 ± 2.0 | 10.5 ± 2.2 | 0.983 |
E/A | 0.94 ± 0.58 | 1.1 ± 0.6 | 0.8 ± 0.6 | 0.089 |
E/e’ | 19.15 ± 8.21 | 20.37 ± 8.59 | 18.03 ± 7.78 | 0.203 |
TR-PG, mmHg | 33.8 ± 14.2 | 40.5 ± 15.4 | 33.4 ± 12.2 | 0.023 |
AR ≥ moderate, n (%) | 8 (9.6) | 5 (12.5) | 3 (7.0) | 0.473 |
AS parameters | ||||
AVA, cm2 | 0.68 ± 0.16 | 0.66 ± 0.17 | 0.70 ± 0.15 | 0.301 |
AVAi, cm2/m2 | 0.48 ± 0.11 | 0.47 ± 0.12 | 0.49 ± 0.10 | 0.401 |
Peak V, m/s | 3.95 ± 0.85 | 3.81 ± 0.87 | 4.08 ± 0.81 | 0.147 |
mPG, mmHg | 37.4 ± 16.3 | 35.6 ± 17.0 | 39.1 ± 15.6 | 0.330 |
MR parameters | ||||
MR jet area, cm2 | 4.1 ± 3.6 | 7.0 ± 2.9 | 1.4 ± 1.2 | < 0.001 |
%MR, % | 20.6 ± 16.5 | 34.0 ± 13.1 | 8.1 ± 6.5 | < 0.001 |
Etiology of MR | ||||
Type I | 16 | 16 | – | – |
Type II | 5 | 5 | – | – |
Type IIIa | 10 | 10 | – | – |
Type IIIb | 9 | 9 | – | – |
Comparison of baseline characteristics between the MR and non-MR group
Time course of change in clinical, laboratory and echocardiography parameters after BAV
Baseline | 1 month after BAV | P value | 3 months after BAV | P value | |
---|---|---|---|---|---|
Clinical data | |||||
NYHA III/IV, n (%) | 28 (70.0) | 1 (2.5) | < 0.001 | 1 (2.5) | < 0.001 |
Laboratory data | |||||
BNP, pg/mL | 702 (391–1042) | 421 (206–618) | 0.002 | 281 (182–401) | < 0.001 |
Conventional echo parameters | |||||
LVEDD, mm | 46.2 ± 6.0 | 45.4 ± 6.5 | 0.237 | 44.0 ± 6.8 | 0.033 |
LVESD, mm | 32.6 ± 6.8 | 31.2 ± 7.7 | 0.148 | 28.6 ± 7.0 | < 0.001 |
LVEF, % | 51.4 ± 13.0 | 54.1 ± 10.1 | 0.089 | 57.4 ± 12.5 | 0.007 |
LVSVI, mL | 38.3 ± 11.7 | 41.3 ± 11.1 | 0.052 | 44.6 ± 11.2 | 0.002 |
E/A | 1.0 (0.6–1.6) | 0.7 (0.6–1.0) | 0.003 | 0.7 (0.5–0.9) | 0.001 |
E/e’ | 20.5 ± 8.7 | 15.5 ± 6.2 | < 0.001 | 16.1 ± 7bnp.1 | 0.002 |
TR-PG, mmHg | 40.5 ± 15.4 | 29.7 ± 8.4 | < 0.001 | 28.9 ± 6.4 | < 0.001 |
AR ≥ moderate, n (%) | 5 (12.5) | 6 (15.0) | 1.000 | 4 (10.0) | 1.000 |
AS parameters | |||||
AVA, cm2 | 0.66 ± 0.17 | 0.84 ± 0.19 | < 0.001 | 0.80 ± 0.20 | 0.001 |
AVAi, cm2/m2 | 0.47 ± 0.12 | 0.59 ± 0.12 | < 0.001 | 0.57 ± 0.12 | < 0.001 |
Peak V, m/s | 61.0 ± 27.1 | 45.0 ± 19.1 | < 0.001 | 51.7 ± 25.1 | 0.002 |
mPG (mmHg) | 35.6 ± 17.0 | 24.9 ± 11.5 | < 0.001 | 29.8 ± 15.2 | 0.003 |
MR parameters | |||||
MR jet area, cm2 | 6.3 (4.5–9.7) | 3.5 (1.5–7.4) | < 0.001 | 2.1 (1.1–6.0) | < 0.001 |
%MR, % | 33.3 (22.6–42.7) | 16.0 (8.9–34.3) | < 0.001 | 12.0 (4.7–29.4) | < 0.001 |
Mitral annular dimension, mm | 28.5 ± 4.9 | 27.2 ± 4.2 | 0.030 | 25.5 ± 3.3 | < 0.001 |
Tenting height, mm | 4.1 ± 1.9 | 3.8 ± 1.9 | 0.307 | 2.8 ± 1.1 | < 0.001 |
Tenting area, mm2 | 58.8 ± 31.6 | 52.0 ± 28.5 | 0.169 | 35.5 ± 14.5 | < 0.001 |
Baseline | 1 month after BAV | P value | 3 months after BAV | P value | |
---|---|---|---|---|---|
Clinical data | |||||
NYHA III/IV, n (%) | 19 (44.2) | 2 (4.5) | < 0.001 | 2 (4.5) | < 0.001 |
Laboratory data | |||||
BNP, pg/mL | 216 (112–422) | 201 (103–405) | 0.293 | 171 (11–368) | 0.086 |
Conventional echo parameters | |||||
LVEDD, mm | 43.2 ± 7.1 | 42.8 ± 6.4 | 0.680 | 42.8 ± 6.4 | 0.659 |
LVESD, mm | 28.9 ± 7.0 | 28.0 ± 6.9 | 0.230 | 27.4 ± 5.8 | 0.091 |
LVEF, % | 58.6 ± 7.8 | 59.8 ± 8.8 | 0.318 | 61.4 ± 7.8 | 0.024 |
LVSVI, mL | 44.7 ± 13.2 | 49.0 ± 13.5 | 0.016 | 49.3 ± 14.7 | 0.009 |
E/A | 0.7 (0.5–0.9) | 0.7 (0.5–0.9) | 0.435 | 0.7 (0.5–0.8) | 0.610 |
E/e’ | 17.8 ± 7.8 | 17.5 ± 8.2 | 0.692 | 18.0 ± 9.9 | 0.918 |
TR-PG, mmHg | 33.4 ± 12.1 | 31.2 ± 13.5 | 0.138 | 30.6 ± 11.4 | 0.151 |
AR ≥ moderate, n (%) | 3 (7.0) | 4 (9.5) | 0.713 | 6 (14.0) | 0.483 |
AS parameters | |||||
AVA, cm2 | 0.70 ± 0.15 | 0.88 ± 0.20 | < 0.001 | 0.84 ± 0.20 | < 0.001 |
AVAi, cm2/m2 | 0.48 ± 0.10 | 0.62 ± 0.14 | < 0.001 | 0.59 ± 0.13 | < 0.001 |
Peak V, m/s | 69.1 ± 27.0 | 53.1 ± 23.1 | < 0.001 | 57.0 ± 23.8 | 0.001 |
mPG (mmHg) | 39.1 ± 15.6 | 30.9 ± 14.2 | < 0.001 | 32.5 ± 14.3 | < 0.001 |
MR parameters | |||||
MR jet area, cm2 | 1.0 (0.3–2.5) | 0.7 (0.2–1.8) | 0.627 | 0.9 (0.3–2.1) | 0.943 |
%MR, % | 7.3 (2.0–12.9) | 4.9 (1.2–11.3) | 0.472 | 4.1 (1.7–12.2) | 0.801 |
Mitral annular dimension, mm | 25.8 ± 3.1 | 23.8 ± 3.4 | 0.001 | 24.7 ± 3.3 | 0.074 |
Tenting height, mm | 3.6 ± 1.6 | 3.0 ± 1.5 | 0.047 | 3.0 ± 1.7 | 0.052 |
Tenting area, mm2 | 46.9 ± 24.0 | 36.5 ± 21.1 | 0.015 | 37.9 ± 25.9 | 0.052 |
Predictors of persisting significant MR at 3 months after BAV
Variables | Univariate analysis | Multivariate analysis | ||||
---|---|---|---|---|---|---|
OR | 95% CI | P value | OR | 95% CI | P value | |
Baseline parameters | ||||||
Age | 1.00 | 0.91–1.11 | 0.940 | |||
Female | 1.86 | 0.50–6.94 | 0.356 | |||
BNP | 1.00 | 1.00–1.00 | 0.130 | |||
NYHA III/IV | 1.29 | 0.31–5.35 | 0.722 | |||
LVESD | 0.96 | 0.87–1.06 | 0.469 | |||
TR-PG | 0.98 | 0.94–1.03 | 0.447 | |||
AVAi | 9.80 | 0.04–2225.02 | 0.410 | |||
LVEF | 1.03 | 0.98–1.09 | 0.253 | |||
MR jet area | 1.21 | 0.96–1.53 | 0.105 | |||
E/e’ | 1.01 | 0.93–1.09 | 0.867 | |||
Change between baseline and 1-month after BAV | ||||||
△LVESD | 1.20 | 1.04–1.40 | 0.015 | 1.36 | 1.05–1.76 | 0.022 |
△TR-PG | 1.05 | 1.00–1.11 | 0.067 | |||
△MR jet area | 1.31 | 1.05–1.62 | 0.016 | 1.95 | 1.16–3.29 | 0.012 |
△AVAi | 0.04 | 0.00–130.06 | 0.443 | |||
△LVEF | 0.99 | 0.93–1.06 | 0.835 | |||
△E/e’ | 1.03 | 0.94–1.12 | 0.510 |