严重的大动脉狭窄的流量梯度模式与保存的喷射分数:临床特征和预测生存的预测因素
Mackram F Eleid1, Paul Sorajja, Hector I Michelena
1Division of Cardiovascular Diseases, Department of Medicine (M.F.E., P.S., H.I.M., J.F.M., P.A.P.), and Division of Biostatistics (C.G.S.), Mayo Clinic College of Medicine, Rochester, MN.
Circulation
|September 20, 2013
概括
患有严重的大动脉狭窄和正常射出分数的患者根据流量和梯度的不同预后. 低流量/低梯度严重的大动脉狭窄表明生存率不佳,但大动脉置换可以改善结果.
科学领域:
- 心脏病学 心脏病学
- 心声回声扫描 (Echocardiography) 是一种心声回声扫描.
- 膜心脏疾病 膜心脏疾病
背景情况:
- 严重的大动脉狭窄 (AS) 保持喷射分数 (PEF) 可以呈现低梯度 (LG) 和减少中风体积,可能表明不良预后.
- 最近提出的流量梯度分类提供了一种新方法来分层患者,并评估PEF严重AS的预后.
研究的目的:
- 为了研究中风体积在患有严重大动脉狭窄和保留射出分数的患者的预后影响.
- 评估流量梯度分类在分层风险和指导管理中对该患者群体的有用性.
主要方法:
- 使用2D和多普勒心声学分析了一组连续1704名患有严重AS (大动脉面积<1.0厘米) 和PEF (≥50%) 的患者队列.
- 患者根据中风体积指数 (低流量[LF]<35mL/m(2) 与正常流量[NF]≥35mL/m(2) 和大动脉梯度 (LG<40mmHg与高梯度[HG]≥40mmHg) 分为四个分层:NF/HG,NF/LG,LF/HG和LF/LG.
- 通过多变量分析,评估了每个组的存活率和大动脉置换 (AVR) 的影响.
主要成果:
- 严重的正常流量/低梯度 (NF/LG) AS与在医疗管理下有利的生存率相关 (2年估计:82%).
- 低流量/低梯度 (LF/LG) 严重的AS (3%的患者) 呈现出减少的射出分数,较高的心房动和心力衰竭的患病率,降低了动脉顺应,以及显著减少的生存率 (2年估计:60%).
- 这种LF/LG模式是死亡率最强的预测因素 (HR,3.26). 在LF/LG和NF/HG组中,AVR显著降低了死亡率 (HR,0.31),但在NF/LG和LF/HG组中没有显示出生存益处.
结论:
- 严重的AS与PEF和正常的流量/低梯度模式表明,在医疗管理下生存率有利,而AVR的影响是中性的.
- 严重的AS与PEF和低流量/低梯度模式与高的并发症率和降低的存活率有关;AVR与这一亚组的存活率改善有关.
- 这些发现强调了流量梯度分类对于准确的风险分层和个性化管理决策在PEF严重AS的重要性.
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