二次 mitra 反的管理:从药物到设备
Cara Barnes1, Harish Sharma2, James Gamble1
1Oxford Heart Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
Heart (British Cardiac Society)
|August 22, 2023
概括
严重的二次 mitrale 吐的结果很差,但像指导方针指导的医学疗法和跨导管边缘到边缘修复 (TEER) 等治疗方法可以提高生存率. 早期干预和优化是改善患者预后的关键.
科学领域:
- 心脏病学 心脏病学
- 干预心脏病学 干预心脏病学
- 心脏门疾病 心脏门疾病
背景情况:
- 严重的二次 mitrale 吐 (SMR) 与高死亡率有关.
- 有有效的治疗方法可用于改善SMR患者的治疗结果.
- 目前的治疗策略需要优化以获得更好的结果.
研究的目的:
- 为了总结严重的二次 mitrale 吐的最最新的治疗方法.
- 倡导积极主动,多方面的方法来管理SMR.
- 要突出跨导管边缘到边缘修复 (TEER) 在选定的患者中的作用.
主要方法:
- 目前针对SMR的指导方针导向医疗疗法的审查.
- 讨论实现鼻节律和心脏再同步治疗 (CRT) 的影响.
- 重点是关干预的作用,特别是TEER,在管理中度至重度的SMR.
主要成果:
- 在40-45%的患者中,指南导向医学疗法 (GDMT) 降低了SMR的严重程度.
- TEER显示治疗所需的数量为心力衰竭患者住院减少3.1,全因死亡率减少5.9.
- 尽管TEER在特定人群中具有合理的成本效益,但在全球范围内仍未得到充分利用.
结论:
- 建议采取积极的策略,包括加快医疗优化,AF管理,CRT和及时转诊以进行中枢干预.
- 对于精心挑选的中度至重度SMR和左心室缩功能差的患者来说,TEER是一种有价值的选择.
- 增加TEER的使用是有必要的,以改善SMR患者的治疗结果.
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