患有不同流量/梯度模式的大动脉狭窄患者的长期结果,接受过导管大动脉植入术
George Oikonomou1, Anastasios Apostolos1, Maria Drakopoulou1
1First Department of Cardiology, National and Kapodistrian University, "Hippokration" General Hospital of Athens, 11527 Athens, Greece.
Journal of clinical medicine
|April 9, 2024
概括
患有低流量低梯度严重大动脉狭窄症 (AS) 的患者在经过过导管大动脉植入 (TAVI) 后改善左心室喷射率 (LVEF),但面临显著更高的5年死亡风险. 低基线中风量指数 (SVi) 预测LVEF的改善.
科学领域:
- 心脏病学 心脏病学
- 干预心脏病学 干预心脏病学
- 心声回声扫描 (Echocardiography) 是一种心声回声扫描.
背景情况:
- 有限的数据存在于长期的结果,严重的大动脉狭窄症 (AS) 患者有不同的流量梯度模式经历过跨导管大动脉植入 (TAVI).
- 了解TAVI前流量梯度模式对长期临床结果和左心室喷射率 (LVEF) 变化的影响至关重要.
研究的目的:
- 评估前TAVI流量梯度模式如何影响TAVI后的长期临床结果.
- 在TAVI之后,评估不同AS亚型之间的LVEF变化.
主要方法:
- 连续接受TAVI治疗的严重AS患者被分为四个TAVI前流量/梯度子组:低流量低梯度 (LF-LG),正常流量低梯度 (NF-LG),低流量高梯度 (LF-HG) 和正常流量高梯度 (NF-HG).
- 在TAVI前和1年后进行过胸腔回声心脏成像.
- 临床随访延长至5年,使用日志等级测试和多变量考克斯回归分析死亡率数据.
主要成果:
- 与其他组相比,LF-LG组 (22.8%) 的1年 (25.8%) 和5年 (64.5%) 的全因死亡率较高.
- 低基线中风量指数 (SVi) 和中度三回是晚期死亡率的独立预测因素.
- 一年后,LF-LG和LF-HG患者显示出显著的LVEF改善;较低的基线LVEF和SVi预测了LVEF改善.
结论:
- 虽然LF-LGAS患者在TAVI后经历了改善的LVEF,但他们面临着极高的5年死亡率.
- 低的跨膜流量,中度的三管吐和TAVI后显著的膜漏与较差的长期结果有关.
- 较低的基线LVEF或SVi预测TAVI后1年有利的LVEF反应.
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