脑卒中体积指数 (SVI) 预测了跨导管大动脉置换 (TAVR) 后所有原因的死亡率
Vinesh R Jonnala1, Haroon S Quadri2, Leili Pourafkari3
1Department of Medicine at Rutgers, Newark, NJ, USA.
概括
患有低流动大动脉狭窄症和左心室功能减弱的患者在经过过导管大动脉置换 (TAVR) 后的生存率下降. 正常流量表明这些接受TAVR的患者的预后更好.
科学领域:
- 心脏病学 心脏病学
- 心脏外科手术 心脏外科手术
- 干预心脏病学 干预心脏病学
背景情况:
- 严重的大动脉狭窄 (AS) 与左心室缩功能障碍可以导致低估AS严重程度,由于低的横膜梯度和低流量状态.
- 低流量与正常流量对左心室喷射分数 (LVEF) 减少的患者进行跨导管大动脉置换 (TAVR) 的影响尚不清楚.
研究的目的:
- 在左心室功能障碍的患者中,根据通过狭窄的大动脉的流量程度来比较生存率.
- 评估中风体积指数 (SVI) 对该患者群体TAVR后生存的预测值.
主要方法:
- 在2012年至2017年期间接受TAVR的LVEF<50%的患者的回顾性审查.
- 利用接收器操作者特征 (ROC) 分析来评估SVI对术后结果的预测价值.
- 采用卡普兰-梅尔和考克斯回归分析来研究低流量状态对五年生存时间的影响.
主要成果:
- 与正常流动AS相比,患有低流动AS (SVI<35 mL/m2) 的患者的五年生存率明显较低.
- 在TAVR后5年的死亡率为低流量组的74%,正常流量组的43% (p ≤0.001).
- ROC分析证实SVI是5年生存时间的显著临床预测因子 (AUC 0.732,p < 0.001).
结论:
- 患有缩功能障碍和低流动AS的患者在TAVR后五年经历了死亡率的增加.
- 在接受TAVR的左心室缩功能减弱的患者中,正常的横膜流状态与更好的预后有关.
- 脑卒中体积指数是降低LVEF的患者的风险分层的关键参数,这些患者接受TAVR治疗,以治疗严重的AS.
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