大动脉狭窄患者的低流量和减少的射出分数不取决于左心室功能
Svante Gersch1,2, Torben Lange1,2, Bo Eric Beuthner1,2
1Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Straße 40, 37075, Göttingen, Germany.
概括
在患有严重的大动脉狭窄和减小射出分数的患者中,低梯度不是由于左心室功能障碍,而是由于其他疾病,如心肌反或心房动.
科学领域:
- 心脏病学 心脏病学
- 心血管成像 - 心血管成像
- 基因组学就是基因组学.
背景情况:
- 严重的大动脉狭窄 (AS) 与左心室喷射分数 (LVEF) 的减少呈现出明显的高梯度 (HG) 和低梯度 (LG) 子组.
- 这些子组的潜在病理生理机制和特征仍然不完全理解.
研究的目的:
- 调查临床,组织学和遗传特征,区分HG-AS和LG-AS患者的LVEF降低.
- 阐明导致LG-AS低流量状态的血液动力学机制.
主要方法:
- 使用了多模式方法,包括临床数据,组织学,下一代测序 (NGS),心声学和心血管磁共振 (CMR) 成像.
- 分析了98名患有AS和减少LVEF的患者,活检样本评估了纤维化和mRNA表达.
主要成果:
- 在HG-AS (n=40) 和LG-AS (n=58) 亚组之间没有观察到LVEF,LV质量或末端透析LV直径的显著差异.
- 心肌纤维化和全球基因表达模式在HG-AS和LG-AS组之间没有差异.
- 在LG-AS患者中,心脏,心房动和右心室功能受损明显更频繁,这可能解释了较高的死亡率.
结论:
- 低流量严重的大动脉狭窄时的低跨心脏梯度和心脏输出主要不是由左心室功能障碍或全球基因表达变化驱动的.
- 额外的心脏病理,包括额头回,心房动和右心室功能障碍,是LG-AS表型的关键贡献者.
- 这些并发症应在LG-AS患者的大动脉置换的管理和规划中考虑.
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