単一または全身的な右心室を有する患者の心不全および心室機能障害
Sanaz Piran1, Gruschen Veldtman, Samuel Siu
1Congenital Cardiac Centre for Adults, Toronto General Hospital, University Health Network, University of Toronto, University of Toronto, Canada.
Circulation
|March 13, 2002
まとめ
単一または全身的な右心室を持つ成人は,心不全と死亡のリスクが高い. 早期発見と介入は,心室機能を保ち,治療結果を改善するために極めて重要です.
科学分野:
- 心臓病学 心臓病学
- 生まれながらの心臓病 生まれながらの心臓病
- 大人の先天性心疾患
背景:
- 以前の研究では,単一/全身性右心室患者の高い充血性心不全率を示しました.
- 成人集団におけるリスクは,ほとんど不明のままでした.
研究 の 目的:
- 単一または全身的な右心室を有する成人の患者における心不全のリスクを評価する.
- この集団における心不全と死亡率の予測要因を特定する.
主な方法:
- 単一または全身的な右心室を持つ188人の成人の患者の見通し評価.
- 室内評価のためのゲートされた放射性核素血管図と2Dエコーカルディオグラフィーを利用しました.
- 臨床フォローアップには,ニューヨーク心臓協会 (NYHA) の分類と死亡率追跡が含まれていました.
主要な成果:
- 心不全の発生率は,手術歴によって変化しました: 22.2% (大動脈のトランスポーゼーションでマスタードの手順), 32.3% (先天的に修正されたトランスポーゼーション), 40% (Fontan-palliated).
- 症状のある患者は,無酸素値とピーク酸素消費量 (VO2) を著しく低下させた.
- 症状のある患者と無症状の患者の間では,全身内室内射出分子が著しく減少した (34.8%対46.7%).
- 症状のある患者 (47.1%) の死亡率は,無症状患者 (5%) と比較して15.7年以上にわたって大幅に高かった.
- NYHAクラス,全身放出分数,および手術時の年齢は,死亡率の主要な予測要因でした.
結論:
- 単一または全身的な右心室を持つ患者は,心不全の重大なリスクと関連する高い死亡率に直面します.
- リスクのある個人を特定することは,心室機能を保全する戦略を実装するために不可欠です.
- 積極的な管理は,この脆弱な患者集団の長期的な結果を改善するために不可欠です.
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