左心室功能的变化和二次 mitrale 排泄的 trancatheter 边缘到边缘修复后的结果
Stamatios Lerakis1, Annapoorna S Kini1, Gennaro Giustino1
1The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York.
概括
过导管边缘到边缘修复 (TEER) 有利于心力衰竭患者,患有严重的二次心肌吐. 单独使用指南导向医学治疗 (GDMT) 的早期左心室喷射分数 (LVEF) 改善没有影响2年后的结果,而TEER持续降低死亡率和住院病例.
科学领域:
- 心脏病学 心脏病学
- 干预心脏病学 干预心脏病学
- 心脏衰竭管理的管理
背景情况:
- 在心力衰竭 (HF) 中,严重的二次 mitrale 吐 (SMR) 带来了重大挑战.
- 过导管端到端修复 (TEER) 已成为SMR的治疗选择.
- 在TEER后早期左心室喷射分数 (LVEF) 变化对长期结果的影响需要进一步调查.
研究的目的:
- 为了评估早期LVEF变化在TEER加指南导向医学治疗 (GDMT) 和单独GDMT后对HF和严重SMR的患者的影响.
- 确定早期LVEF反应是否会影响TEER在降低死亡率和HF住院治疗的有效性.
主要方法:
- 对COAPT试验数据的分析,重点是对应心声图数据的患者.
- 评估从基线到干预后30天的LVEF变化.
- 主要结局:综合所有原因死亡或HF住院治疗 (HFH) 从30天到2年.
主要成果:
- 早期的LVEF增加更频繁地发生在单独使用GDMT时 (51.4%),而不是TEER加GDMT (33.0%).
- 在LVEF增加与减少/30天到2年没有变化的患者之间,死亡或HFH没有显著差异 (58.8%与51.4%).
- 与单独使用GDMT相比,TEER加GDMT始终减少死亡或HFH,无论早期LVEF变化 (Pint = 0.75).
结论:
- 在严重SMR的HF中,干预后早期的LVEF改善更常见于单独使用GDMT,但与2年后的结果无关.
- 在2年内,TEER在减少死亡或HFH方面表现出持续的好处,独立于早期LVEF反应.
- 无论初始的LVEF变化,TEER有效地改善了HF和严重SMR患者的治疗结果.
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