臨床実務における大動脈吐の死亡率と罹患率. 長期フォローアップ研究である
K S Dujardin1, M Enriquez-Sarano, H V Schaff
1Division of Cardiovascular Diseases, Section of Cardiovascular Surgery, Mayo Clinic and Mayo Foundation, Rochester, MI, USA.
Circulation
|April 13, 1999
まとめ
重度の大動脈反発の保守的な管理は,予想よりも高い死亡率と発症率につながる. 高リスク患者の場合,心疾患による死亡率を低減するために,迅速な外科的検討が不可欠です.
科学分野:
- 心臓病学 心臓病学
- 心血管医学 心血管医学
- エコーカルディオグラフィー エコーカルディオグラフィー
背景:
- 保守的に管理される大動脈吐症の患者の長期的な予後はよく確立されていません.
- 大動脈反発 (AR) は,注意深い管理戦略を必要とする重要な心血管疾患です.
研究 の 目的:
- 保守的な管理下で重度または中度重度の大動脈吐症の患者の長期的なアウトカムを分析する.
- この患者コホートにおける生存と心血管疾患の予測要因を特定する.
- 死亡率に対する外科介入の影響を評価する.
主な方法:
- カラードップラーエコーカルディオグラフィによる大動脈吐と診断された246人の患者の遡及的分析.
- 10年間の死亡率,心不全,大動脈弁手術率,心血管疾患の評価.
- 多変量分析により,生存の独立した予測要因と,心血管疾患による死亡率に対する手術の効果を決定する.
主要な成果:
- 保守的な管理により,10年間の死亡率は34+/-5%と高罹患率となり,心不全は47+/-6%,大動脈弁手術は62+/-4%となった.
- 10年後には,患者の75+/-3%が死亡または手術を受け,83+/-3%が心血管疾患を経験しました.
- 生存の予測要因には,年齢,機能的階級,併発性指数,心房細動,左心室末縮直径が含まれる. 手術は,心血管疾患による死亡率の低下と関連していた (調整された危険比率,0.54;P=0.048).
結論:
- 保守的に管理される重度の大動脈吐は,過剰な死亡率と有意な罹病率に関連しており,深刻な疾患の予後を示しています.
- 高リスク患者の場合,心臓病による死亡率を軽減するために,迅速な外科介入を検討する必要があります.
- 左心室のエジェクション分数とエンド・シストリック直径は,大動脈吐におけるリスク層分化の重要な指標である.
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