重度の大動脈吐症の患者におけるミトラル吐症の予後的な影響
Ramdas G Pai1, Padmini Varadarajan
1Division of Cardiology, Loma Linda University Medical Center, Loma Linda, CA 92354, USA. ramdaspai@yahoo.com
Circulation
|September 15, 2010
まとめ
ミトラルリグルジテーション (MR) は重度の大動脈リグルジテーション (AR) で一般的です. 大動脈弁置換 (AVR) とミトラ弁修復によるMR治療は,これらの患者の生存率を改善します.
科学分野:
- 心臓病学 心臓病学
- 心臓外科手術について
- 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:
- 重度の大動脈吐症 (AR) は,しばしばミトラル吐症 (MR) と同時発生する.
- 重度のAR患者におけるMRの臨床的および予後的な影響は十分に確立されていません.
- MRは心房細動,心不全を引き起こす可能性があり,大動脈弁置換 (AVR) 時にミトラル弁手術を必要とします.
研究 の 目的:
- 重度の大動脈吐症 (AR) の患者におけるミトラル吐症 (MR) の有病率と予後的意義を調査する.
- この患者コホートにおける大動脈弁置換 (AVR) と併発性ミトラ弁修復の生存への影響を評価する.
主な方法:
- 1993年から2007年の間に重度のARを発症した756人の患者の遡及的分析.
- エコーカルディオグラフィのデータと臨床情報を検討した.
- 死亡率のデータは,国家死亡指数から得られ,MRの重症度に基づいて分析されました.
主要な成果:
- 重度のAR患者の45%が中等度から重度のMR (グレード≥2+) を有していた.
- 生存率は,MRの重症度が増加するにつれて徐々に減少した (P<0.0001).
- 同時にミトラ弁を修復した大動脈弁置換 (AVR) は,3+または4+MR (HR 0.29,P=0.02) の患者で生存率の改善と関連していました.
結論:
- 中度から重度のミトラル反発 (MR) は重度の大動脈反発 (AR) で一般的であり,独立して生存率の低下を予測します.
- 大動脈弁置換 (AVR) と同時にミトラ弁の修復は,生存結果を大幅に改善します.
- 重度のAR患者のMRの発症は,無症状の個体でも,AVRの検討を促すべきである.
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