重度の大動脈狭窄症における心筋痕と死亡率
Tarique A Musa1, Thomas A Treibel2, Vassiliou S Vassiliou3
1Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, UK (T.A.M., L.E.D., J.R.J.F., P.B., G.R.L., J.P.G.).
Circulation
|July 14, 2018
まとめ
重度の大動脈狭窄症患者の心血管磁気共振で検出された焦点性心筋痕は,独立して長期的な死亡率を予測します. 大動脈弁の置換の種類に関係なく この傷跡の存在は 遅い死亡リスクを2倍にします
科学分野:
- 心臓病科
- 心血管イメージング
- 心臓外科
背景:
- 大動脈閉塞に対する大動脈弁置換 (AVR) は,通常,症状の発現によってタイミングが決まります.
- 遅いAVRは不可逆的な心筋機能不全と手術のリスク増加につながる.
- 手術前における心筋の健康状態の評価は 手術のタイミングと患者の結果の最適化に不可欠です
研究 の 目的:
- 重度の大動脈狭窄症患者の手術前の焦点性心筋痕と長期的な死亡率との関連を調査する.
- 心筋の傷跡のパターンと負荷が他のリスク要因とは独立して死亡率を予測するかどうかを判断する.
主な方法:
- AVRを受けた重度の大動脈狭窄症患者の674人を対象とした長期観察結果研究.
- 術前の心血管磁気共振 (CMR) を用いて,心筋の傷跡 (心筋梗塞および心筋梗塞以外のパターン) を定量化しました.
- 生存分析は,全因および心血管疾患による死亡率を追跡するために,平均3. 6年の追跡期間で行われました.
主要な成果:
- 患者の51%に心筋の傷がみられた (18%は心筋梗塞,33%は心筋梗塞ではない).
- すべての原因による死亡率 (HR2. 39) と心血管疾患による死亡率 (HR2. 64) を独立に予測した.
- すべての原因による死亡のリスクが11%,心血管疾患による死亡リスクが8%増加した.
結論:
- 遅いガドリニウム増強は,重度の大動脈狭窄における死亡率の独立した予測因子である.
- 心筋の傷跡の存在は 遅い死亡リスクの2倍と関連しています
- これらの発見は,重度の大動脈狭窄の患者の心筋痕の評価が,リスクの階層化と外科的意思決定を精密にするために重要であることを強調しています.
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