在所有血液动力学亚型中,具有矛盾的低流量,低梯度的大动脉狭窄症的患者从TAVI中获得的益处最小
Miriam Puls1, Bo Eric Beuthner2, Rodi Topci2
1Clinic of Cardiology and Pneumology, University Medical Center Göttingen, 37099, Göttingen, Germany. dr.m.puls@med.uni-goettingen.de.
概括
具有矛盾的低流量,低梯度的大动脉狭窄症 (PLF-LG AS) 的患者从TAVI中获得的益处最小. 这种严重的AS亚型在手术后显示出较高的死亡率和较差的结果,与其他AS组相比.
科学领域:
- 心脏病学 心脏病学
- 干预心脏病学 干预心脏病学
- 心脏外科手术 心脏外科手术
背景情况:
- 严重的大动脉狭窄症 (AS) 管理,特别是透导管大动脉植入 (TAVI),对于特定的患者亚组仍然存在争议.
- 在具有悖论性低流量,低梯度AS (PLF-LG AS) 的患者中,TAVI的临床益处仍在争论中.
- 在指南中定义的AS亚型需要对TAVI疗效进行单独的评估.
研究的目的:
- 为了比较不同指南定义的AS亚型的TAVI后临床益处.
- 评估长期死亡率,心力衰竭症状的改善,以及TAVI后的心脏逆转改造.
- 为了确定从TAVI中获益最小的AS亚型.
主要方法:
- 未来包括250名连续TAVI患者.
- 评估心声回声学 (TTE),6分钟步行测试 (6mwt),明尼苏达州生活与心力衰竭问卷 (MLHFQ),NYHA状态,和NT-proBNP在基线和6个月.
- 在3-5年内评估长期死亡率和死亡原因.
主要成果:
- 患者被分为正常EF/高梯度 (NEF-HG AS),低EF/高梯度 (LEF-HG AS),经典低流/低梯度 (LEF-LG AS) 和矛盾的低流/低梯度 (PLF-LG AS) AS亚型.
- 塔维改善了所有亚型的MLHFQ得分和NT-proBNP水平,除了PLF-LG AS.
- PLF-LG AS患者表现出最差的生存率,特别是心血管 (CV) 和心脏突然死亡 (SCD),并且在TAVI后表现出最少的心脏逆转重塑.
- PLF-LG AS是心血管死亡率的独立预测因素.
结论:
- 与其他AS亚型相比,PLF-LGAS患者从TAVI中获得的临床益处最小.
- 这个小组表现出更高的死亡率 (CV和SCD),减少症状改善,并在TAVI后进行最小的心脏逆转重塑.
- 这些发现表明,根据目前的结果,PLF-LG AS患者可能不是TAVI的理想候选人.
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