左心室喷射分数和大动脉梯度对跨导管大动脉干预后死亡率的影响
Ian C Gilchrist1, Smadar Kort1, Ting-Yu Wang1
1Department of Medicine, Renaissance School of Medicine, State University of New York at Stony Brook, Stony Brook, NY, USA.
概括
过导管大动脉干预 (TAVI) 的结果受到左心室喷射率 (LVEF) 和大动脉梯度 (AVG) 的减少的影响. 虽然降低的AVG独立地预测了更高的死亡率,但降低的LVEF却没有,尽管最初的未调整的死亡率更高.
科学领域:
- 心血管医学 心血管医学
- 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:
- 关于左心室喷射分数 (LVEF) 的减少和大动脉梯度 (AVG) 的平均值对跨导管大动脉干预 (TAVI) 后的结果的影响,存在相互矛盾的数据.
- 了解这些因素对于TAVI程序中的患者选择和风险分层至关重要.
研究的目的:
- 在接受TAVI的患者中,评估基线LVEF,AVG和1年全因死亡率之间的关系.
- 确定是否降低LVEF或降低AVG是TAVI后死亡率的独立预测因素.
主要方法:
- 分析了2015-2018年连续接受TAVI的298名成年患者的潜在注册表.
- 患者根据基线LVEF (≤45%对>45%) 和平均AVG (<40mmHg对≥40mmHg) 进行了分类.
- 主要终点是随访1年的全因死亡率.
主要成果:
- 患有LVEF≤45% (22.1%) 和AVG<40mmHg (58.1%) 的患者的1年死亡率明显更高.
- 多变量分析显示,较高的AVG (每毫米克) 独立地与较低的1年死亡率相关 (OR 0.97,p=0.026).
- 在风险调整分析中,降低的LVEF与1年死亡率没有独立相关 (OR 0.98).
结论:
- 在当代TAVI患者中,降低AVG是增加1年死亡率的独立预测因素.
- 降低的LVEF虽然与较高的未调整死亡率相关,但不能独立预测TAVI后的死亡率.
- 这些发现完善了TAVI患者的风险分层,突出了AVG对LVEF在调整后的分析中的预后意义.
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