トランスキャテーターによる大動脈弁のインプラントによって誘発された左束枝ブロックは,死亡のリスクを増加させます
Patrick Houthuizen1, Leen A F M Van Garsse, Thomas T Poels
1Maastricht University Medical Center, Maastricht, Netherlands.
Circulation
|July 14, 2012
まとめ
トランスキャテーター大動脈弁の埋め込み (TAVI) は,新しい左束枝ブロック (LBBB) を引き起こし,死亡リスクを増やす可能性があります. この研究では,TAVI誘発のLBBBは重度の大動脈狭窄症の患者の死亡の独立した予測因子であることが判明しました.
科学分野:
- 心臓病学 心臓病学
- 介入性心臓病学 介入性心臓病学
- 心臓電気生理学 心臓電気生理学
背景:
- トランスキャテータ大動脈弁の埋め込み (TAVI) は,重度の大動脈狭窄症の重要な治療法です.
- TAVI患者の30~50%に新規発症した左束枝ブロック (LBBB) が発生するが,その臨床的影響は不明である.
研究 の 目的:
- TAVI後に新たに発症したLBBBとあらゆる原因による死亡率との関連性を調査する.
- TAVI患者の死亡率の予測要因を特定する.
主な方法:
- マルチセンターレジストリーは,TAVI患者のデータ (2005年-2010年) を収集した.
- すべての原因による死亡率は,新しいLBBBを発症した患者と,発症しなかった患者との間で比較されました.
- 多変量回帰分析により,死亡率の独立した予測要因が特定されました.
主要な成果:
- 679人の患者のうち,233人 (34.3%) がTAVI後の新しいLBBBを発症した.
- すべての原因による死亡率は,LBBBの患者 (37.8%) と,LBBBの患者 (24.0%) (P=0.002) と比べて,著しく高かった.
- TAVI誘発のLBBBは,COPD,女性の性別,低射出分数,および高いクレアチニンとともに,死亡率の独立した予測因子でした.
結論:
- TAVI後の新規発症のLBBBは,全因死亡率の増加と関連しています.
- TAVI誘発のLBBBは,手術を受ける患者の死亡率の独立したリスク因子です.
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