通过早期活检和结果证明的充满性心肌炎
Florent Huang1,2, Enrico Ammirati3, Maharajah Ponnaiah4
1Department of Cardiology, Foch Hospital, Suresnes, France.
European heart journal
|November 9, 2023
概括
在充性心肌炎患者中,迅速的内心肌瘤活检 (EMB) 显著改善了没有心脏移植或LVAD的存活率. 早期的EMB对于在重症监护机构获得更好的结果至关重要.
科学领域:
- 心脏病学 心脏病学
- 密集护理医学 密集护理医学
- 病理学 病理学 病理学
背景情况:
- 发性心肌炎需要及时诊断和管理.
- 建议进行心脏内膜活检 (EMB),但其最佳时间仍在争论中.
- 了解EMB时间的影响对于患者的治疗结果至关重要.
研究的目的:
- 评估早期与延迟内心肌瘤活检 (EMB) 在患有 fulminant心肌炎的成年患者的临床影响.
- 为了确定即时EMB是否会影响无心脏移植 (HTx) 或左心室辅助装置 (LVAD) 的存活率.
主要方法:
- 一项全球队列研究包括419名怀疑患有发性心肌炎的成年患者.
- 通过EMB或尸检,或通过心脏MRI,通过组织学证实了诊断.
- 倾向分数加权分析比较了早期 (≤2天) 和延迟EMB组之间的结果.
主要成果:
- 与延迟EMB相比,早期EMB与无HTx/LVAD的1年生存率显著改善 (63%对40%).
- 快速EMB独立地与较低的死亡率或HTx/LVAD (OR 0.44) 相关.
- 在研究队列中,1年后无HTx/LVAD的总生存率为65%.
结论:
- 在重症监护病房的患者中,应立即进行内心肌瘤活检,怀疑患有发性心肌炎.
- 早期的EMB与改善的临床结果有关,减少了对心脏移植或LVAD的需求.
- 这支持EMB在急性心肌炎的重症监护机构的广泛及时使用.
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