在经过手术干预的古典低流,低梯度的大动脉狭窄症患者的风险预测
Fernanda Castiglioni Tessari1, Maria Antonieta Albanez A de M Lopes1,2, Carlos M Campos1,3
1Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil.
Frontiers in cardiovascular medicine
|June 28, 2023
概括
在接受大动脉置换手术 (SAVR) 的低流量,低梯度大动脉狭窄症 (LFLG-AS) 患者中,平均25mmHg或更低的跨大动脉梯度是死亡率的主要预测因素. 左心室流量储备不会影响长期结果.
科学领域:
- 心脏病学 心脏病学
- 心脏外科手术 心脏外科手术
- 心声回声扫描 (Echocardiography) 是一种心声回声扫描.
- 心脏磁共振成像 - - 心脏磁共振成像
背景情况:
- 经典的低流量,低梯度的大动脉狭窄 (LFLG-AS) 呈现出不良预后和高死亡风险与当前的治疗.
- 有需要可靠的风险评估工具LFLG-AS患者进行大动脉置换手术 (SAVR).
研究的目的:
- 在接受SAVR的古典LFLG-AS患者中确定死亡预测因子.
- 为了评估这个患者群体中平均门梯度和流量储备的预后值.
主要方法:
- 对41名接受SAVR的LFLG-AS患者进行前性研究.
- 使用多布他胺应激回声心电图 (DSE),3D回声心电图和T1绘制心脏磁共振 (CMR).
- 排除了伪严重的大动脉狭窄的患者;分析了30天和1年的死亡率.
主要成果:
- 死亡率的唯一独立预测因子是中位跨梯度 (HR:0.923,p=0.019).
- 平均尾梯度≤25 mmHg与显著更高的全因死亡率相关 (日志排名p=0.038).
- 左心室流量储备 (FR) 状态在死亡率上没有显著差异 (逻辑等级p=0.114).
结论:
- 平均的脑梯度是接受SAVR的LFLG-AS患者死亡率的关键独立预测指标.
- 平均脑脊梯度≤25mmHg标明了需要更密切监测或替代治疗策略的高风险子组.
- 左心室流量储备不是这个队列中长期结果的可靠预后指标.
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