発血性ミトラル吐:定量的なドップラー評価による長期的な結果と予後的な影響
F Grigioni1, M Enriquez-Sarano, K J Zehr
1Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA.
Circulation
|April 3, 2001
まとめ
慢性的な心筋梗塞 (MI) の後の段階では,不全性ミトラル吐 (IMR) の存在が死亡リスクを大幅に増加させます. 排泄量と効果的な排泄孔で測定されるIMRの程度は,この高いリスクと直接相関しています.
科学分野:
- 心臓病学 心臓病学
- 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
- 心臓外科手術について
背景:
- 心筋梗塞 (MI) は,不全性ミトラル吐 (IMR) を引き起こす可能性があります.
- IMRは,急性および早期のMI後の段階における既知の悪い予後指標である.
- 慢性的なMI後の段階におけるIMRの予後的な影響はよく定義されていません.
研究 の 目的:
- 慢性的なポストMI患者のIMRの予後的影響を調査する.
- IMRの存在と重度が死亡率の増加と関連しているかどうかを判断する.
- リスクの階層化のためのIMR定量化の価値を評価する.
主な方法:
- Q波MI (>16日) を経験した303人の患者の分析.
- トランストラシックエコーカルディオグラフィは,IMR,リグルジント体積 (RVol),および有効なリグルジント開口 (ERO) 面積を評価します.
- 多変量分析による全死亡率と心臓死亡率の5年間の追跡調査.
主要な成果:
- IMRを患った患者は,IMRを患っていない患者と比較して,5年間の合計 (62%対39%) と心臓死亡率 (50%対30%) が著しく高かった.
- IMRの存在は,増加した全死亡率と心臓死亡率の独立した予測因子でした (aRRはそれぞれ1.88と1.83).
- IMRのより高い程度 (RVol ≥30 mLまたはERO ≥20 mm2) は,さらに死亡リスクの増加と関連していました.
結論:
- 慢性的なポストMI段階では,IMRの存在は,ベースラインの特徴と心室機能不全から独立して,過剰な死亡率と関連しています.
- EROとRVol.によって定量化されたIMRの度合いで死亡リスクは上昇します.
- IMRの検出と定量化は,慢性的なポストMI患者におけるリスクの階層化と臨床的意思決定において極めて重要です.
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