严重的大动脉狭窄的心肌痕和死亡率
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
概括
通过心血管磁共振检测到重度大动脉狭窄患者的焦点心肌痕独立预测长期死亡率. 这种痕增加了晚期死亡风险的两倍, 不管有多种类型的动脉置换.
科学领域:
- 心脏病学
- 心血管成像
- 心脏外科
背景情况:
- 大动脉置换 (AVR) 对于大动脉狭窄通常是随着症状的发展而进行的.
- 晚期AVR可能导致不可逆转的心肌功能障碍和手术风险增加.
- 术前对心肌健康的评估对于优化手术时间和患者的结果至关重要.
研究的目的:
- 在患有重症大动脉狭窄症的患者中,研究手术前的焦点心肌痕与长期死亡率之间的关联.
- 要确定心肌痕模式和负担是否独立于其他风险因素预测死亡率.
主要方法:
- 这是一项长度观察结果研究,涉及674名接受AVR的重症大动脉狭窄患者.
- 使用手术前心血管磁共振 (CMR) 来量化心肌痕 (心脏病发作和非心脏病发作模式).
- 进行了生存分析以追踪所有原因和心血管死亡率,平均随访时间为3. 6年.
主要成果:
- 在51%的患者中存在心肌痕 (18%为心脏病发作,33%为非心脏病发作).
- 痕存在独立预测所有原因死亡率 (HR 2.39) 和心血管死亡率 (HR 2.64).
- 每增加1%的痕负担与11%更高的全因死亡风险和8%更高的心血管死亡风险有关.
结论:
- 晚期加多增强在CMR上,表明心肌痕,是严重的大动脉狭窄死亡的独立预测因子.
- 心肌痕的存在与晚期死亡风险增加了两倍.
- 这些发现强调了评估严重的大动脉狭窄患者的心肌痕的重要性,以完善风险分层和手术决策.
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