在患有低流量非常低梯度的大动脉狭窄症的患者中,透管大动脉置换的结果
Hiroki A Ueyama1,2,3, Lakshay Chopra1,2, Ankur Dalsania1
1Division of Cardiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, One Gustave L. Levy Place, New York, NY 10029, USA.
European heart journal. Cardiovascular Imaging
|September 29, 2023
概括
患有严重的大动脉狭窄和非常低流量低梯度 (LG) 的患者的结果更差. 超导管大动脉置换 (TAVR) 在这个不同的人群中没有显示好处,这表明需要进一步研究.
科学领域:
- 心脏病学 心脏病学
- 干预心脏病学 干预心脏病学
- 心脏外科手术 心脏外科手术
背景情况:
- 严重的大动脉狭窄 (AS) 低流低梯度 (LG) 与预后不佳有关.
- 流量非常低的LG (平均压力梯度≤20 mmHg) 可能表明患有高级心脏功能障碍的独特患者子组.
研究的目的:
- 为了表征患有非常低流量LG严重AS的患者.
- 评估该特定AS群体的临床结果和TAVR益处.
主要方法:
- 单一中心对662名低流重症AS患者 (2019-2021) 的回顾性研究.
- 患者被分为非常LG (MPG ≤20 mmHg),LG (20
- 组合终点的比较 (所有原因死亡率,心力衰竭再住院) 在组之间和TAVR后与保守管理相比.
主要成果:
- 与LG (51%) 和HG (29%) 组相比,LG队列 (20%) 的共发病率更高,LVEF (45%) 较低.
- 随着MPG的下降,观察到不良事件的逐渐增加.
- 在TAVR接受者中,非常高的LG是不良结果的独立预测因子 (aHR 2.42).
- 在LG和HG组中,TAVR减少了不良事件,但在LG组中没有减少 (aHR为0.69).
结论:
- 非常低流的LG严重AS定义了一个独特的患者群体,具有相当大的并发症和较差的结果.
- 在这个特定的亚组中,透气管大动脉置换 (TAVR) 似乎没有赋予生存或再入院的好处.
- 需要进一步的研究,以确定在患有非常低流量LG严重AS的患者中最佳的管理策略和TAVR疗效.
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