对肝移植候选人的心脏评估
Stephen Possick1, Vandana Khungar2, Ranjit Deshpande3
1Yale University School of Medicine, Cardiovascular Medicine.
Current opinion in organ transplantation
|November 23, 2023
概括
肝移植候选人心脏评估的近期进展包括更新的肝硬化心肌病标准和改进的肺高血压评估. 冠状动脉计算机断层扫描血管造影 (CCTA) 和冠状动脉评分等非侵入性测试可以改善阻塞性冠状动脉疾病的风险分层.
科学领域:
- 心脏病学 心脏病学
- 肝病学 肝病学是一种肝病学.
- 移植手术 移植手术
背景情况:
- 对于肝移植候选人来说,心脏评估至关重要.
- 阻塞性冠状动脉疾病 (CAD) 和肝硬化心肌病是令人担忧的重大问题.
- 传统的评估方法有其局限性.
研究的目的:
- 要总结最近对成年肝移植候选人的心脏评估的变化.
- 突出非侵入性测试和诊断标准方面的进展.
- 讨论最新的指导方针和新兴疗法.
主要方法:
- 审查最近的文献和指导方针.
- 专注于冠状动脉计算机断层扫描血管学 (CCTA) 有或没有分数流量储备 (FFR).
- 强调冠状动脉评分风险分层.
- 对肝硬化心肌病和肺高血压的更新回声心脏学参数的评估.
主要成果:
- CCTA显示高负预测值,但可以有错误的阳性.
- 修订的肝硬化心肌病标准提高了外科手术期间风险分层.
- 更新的肺高血压标准改善了对右心导管导管的指导.
- 透导管大动脉置换 (TAVR) 在肝硬化患者中显示出新兴的安全性和有效性.
结论:
- 非侵入性检测 (CCTA,冠状动脉评分) 可以减少对冠状动脉血管学的依赖.
- 2020年肝硬化心肌病标准改善了对心和腹功能的评估.
- 全球应变分数提供了超越弹射率的宝贵见解.
- 简化肺压标准有助于评估和后续行动.
- 透导管技术为高风险患者的膜疾病提供了新的选择.
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