术前左心室收缩储备对低梯度大动脉狭窄症中术后喷射率的影响
Jean-Paul Quere1, Jean-Luc Monin, Franck Levy
1Department of Cardiology, INSERM, ERI-12, University Hospital, Amiens, France.
Circulation
|April 6, 2006
概括
多布他胺应激血液动力学 (DSH) 可以评估低梯度大动脉狭窄 (AS) 的手术风险. 缺少DSH的收缩储备并不能预测幸存者在大动脉置换 (AVR) 后左心室喷射分数 (LVEF) 恢复不良.
科学领域:
- 心脏病学 心脏病学
- 心脏外科手术 心脏外科手术
- 血液动力学 血液动力学
背景情况:
- 低梯度大动脉狭窄症 (AS) 在手术风险分层方面存在挑战.
- 多布胺应激血动力学 (DSH) 是评估手术风险的潜在工具.
- 在AS中,左心室收缩储备和术后左心室喷射分数 (LVEF) 之间的关系需要进一步研究.
研究的目的:
- 评估DSH对手术后LVEF改善的预测值,在患有低梯度AS的患者中.
- 评估左心室收缩储备对大动脉置换 (AVR) 后LVEF恢复的影响.
主要方法:
- 预计将招募66名患有症状严重AS的患者,LVEF≤40%,平均梯度≤40mmHg.
- 使用DSH评估手术前收缩储备.
- 在AVR后的随访中评估LVEF和纽约心脏协会 (NYHA) 类变化.
主要成果:
- 58%的患者在AVR后改善了2个NYHA类,平均LVEF从29%增加到47%.
- 83%的收缩储备患者和65%的没有收缩储备的患者的LVEF有所改善,群体之间的LVEF平均改善类似.
- 多变量分析确定了多血管冠状动脉疾病和基线平均心关压梯度,但不是收缩储量,作为LVEF改善的预测因素.
结论:
- 在经过手术幸存下来的低梯度AS患者中,AVR后LVEF通常会增加.
- 缺少DSH的收缩储备与更高的手术死亡率有关,但并不排除幸存者的LVEF恢复.
- 对低梯度AS的手术不应仅仅基于DSH上缺乏收缩储备而违禁.
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