严重的大动脉狭窄症中的定量流体过载细化了心脏损伤,并与更糟糕的结果相关
Kseniya Halavina1, Matthias Koschutnik1, Carolina Donà1
1Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria.
European journal of heart failure
|July 18, 2023
概括
在患有严重大动脉狭窄症 (AS) 的患者中,液体过载 (FO) 显著预测了通过导管大动脉植入 (TAVI) 后的不良结果. 使用生物阻抗光谱学量化FO可以提高风险分层,超出传统标记.
科学领域:
- 心脏病学 心脏病学
- 医疗技术 医疗技术 医学技术
- 临床风险评估临床风险评估
背景情况:
- 严重的大动脉狭窄 (AS) 的心脏失补偿与额外膜损伤和流体过载 (FO) 有关.
- 生物阻抗光谱 (BIS) 提供了对FO的客观量化.
- 既有风险分层方法可能无法完全捕捉FO的预后影响.
研究的目的:
- 评估FO的预后值,由BIS量化,在接受过导管大动脉植入 (TAVI) 的严重AS患者中.
- 确定FO是否提供超越现有的心脏损伤标志物和临床风险得分的增量预后信息.
- 评估FO和右侧心脏损伤 (rCD) 对TAVI后结果的综合预后影响.
主要方法:
- 预期评估880名重症AS患者的TAVI计划使用BIS和心声回声.
- 由BIS定义的FO为≥1.0 L;通过心声学评估的rCD.
- 主要终点:住院治疗心力衰竭 (HHF) 和/或死亡.
主要成果:
- 41%的患者有FO;超过50%的患者没有出现血栓塞的临床迹象.
- 每增加1.0L的FO与13%的事件危险增加有关 (aHR1.13).
- 与NT-proBNP,EuroSCORE II和心声回声学发现相比,FO提供了增量预后价值;联合FO和rCD分层确定了高风险群体.
结论:
- 通过BIS进行的定量FO测量显著改善了在接受TAVI治疗的严重AS患者的风险预测.
- FO提供了超越传统标记的预测信息,有助于更精确的风险分层.
- 对FO和心脏损伤的综合评估完善了TAVI候选人的结果预测.
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