不一致的低梯度严重大动脉狭窄症的预后影响:对大型多中心注册表的全面分析
David De Azevedo1, Christophe Tribouilloy2,3, Sylvestre Maréchaux4
1Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, and IREC/CARD UCLouvain, Brussels, Belgium.
JACC. Advances
|June 28, 2024
概括
不一致的低梯度严重大动脉狭窄症 (DLG-SAS) 的存活率比高梯度SAS更好,但比中度AS更差. 预后随着较低的膜面积或较高的梯度而恶化,表明DLG-SAS是一种中间疾病形式.
科学领域:
- 心脏病学 心脏病学
- 膜心脏疾病 膜心脏疾病
- 大动脉狭窄症 大动脉狭窄症
背景情况:
- 严重的大动脉狭窄 (SAS) 具有低的横膜梯度和正常的射出分数,影响高达30%的患者.
- 这种不和的低梯度SAS (DLG-SAS) 的预后意义仍在争论中.
研究的目的:
- 为了比较DLG-SAS与中度大动脉狭窄 (MAS) 和高梯度SAS (HG-SAS) 的结果.
主要方法:
- 使用BEL-F-ASt注册表 (n=2,582) 分析大动脉狭窄症 (AS) 患者.
- 使用逆概率加权和倾向性得分匹配,比较整体和未手术患者的生存率 (n=1,812).
- 基于平均梯度 (MG) 和指数化大动脉膜面积 (AVAi) 值的分析结果.
主要成果:
- 在MAS (58.9%) 中,五年生存率明显优于DLG-SAS (47%) 和HG-SAS (41.2%) (P < 0.001).
- 在未手术的患者中,生存率遵循相同的趋势:MAS (54.1%) > DLG-SAS (37.9%) > HG-SAS (28.1%) (P < 0.001).
- 在可比的平均梯度下,较低的AVAi与更差的预后相关;在可比的AVAi下,较高的平均梯度表明预后更差.
结论:
- DLG-SAS的存活率是中等的,比MAS更差,但比HG-SAS更好.
- 这些发现表明DLG-SAS代表了大动脉狭窄疾病连续体内的独特实体.
- 预后受到梯度和门区域严重性的影响,突出显示了DLG-SAS评估的复杂性.
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