重要な二次性三角管吐症の患者における右心房再構成と機能の予後的な影響
Marlieke F Dietz1, Edgard A Prihadi1,2, Pieter van der Bijl1
1Department of Cardiology (M.F.D., E.A.P., P.v.d.B., L.G., E.G., O.S.v.G., N.A.M., V.D., J.J.B.), Leiden University Medical Center, The Netherlands.
Circulation
|June 13, 2019
まとめ
右心室収縮機能不全は,二次性三角吐症の患者で,大きく悪化する. 早期の介入は,これらの個体における生存率の改善に不可欠です.
科学分野:
- 心臓病科
- エコーカルディオグラフィー
- 心臓外科
背景:
- トリコスピッド吐 (TR) の管理は右心房 (RV) のサイズと機能に左右されます.
- 二次的なTRにおけるRV改造は,まだ十分に理解されていない.
- この研究は,重要な二次TRにおけるRV再構成パターンとその予後値を定義することを目的とした.
研究 の 目的:
- 重要な二次性TRを有する患者のRV再構成の特徴を明らかにする.
- 異なるRV改造パターンの予後的な影響を調査する.
- TRの介入に関する臨床的決定を基にします.
主な方法:
- トランストラシック・エコーカルディオグラフィーは,有意な二次TRを持つ1292人の患者で,RV再構成を評価するために使用されました.
- 4つのRV再構成パターンはRVの膨張とシストリック機能に基づいて定義された.
- すべての原因による死亡率が主なエンドポイントで,再構成パターンの間のイベント率が比較されました.
主要な成果:
- 43%の患者は,男性性,併発性,および症状に関連した,縮性機能不全 (パターン4) を伴う拡張性RVを持っていた.
- 5年生存率は,パターン1 (正常なRV,収縮機能障害) と比較して,パターン3 (正常なRV,収縮機能障害) で有意に低下した.
- 拡張に関係なく,RVの収縮機能不全は,悪い結果の独立した予測因子でした.
結論:
- 重度の二次性TRにおける予後不良の重要な決定因子である.
- RVの縮小機能が既に存在している場合,RVの縮小機能の出現は結果をさらに悪化させない.
- これらの発見は,二次性TRの管理におけるRVシストリック機能の評価の重要性を強調しています.
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