冲击指数肌素的预后值在患有严重大动脉狭窄症的患者中,接受过导管大动脉置换术
Bangyuan Yang1, Changjin Wang1, Ting Zhou1
1Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China.
Cardiorenal medicine
|September 22, 2024
概括
冲击指数肌素 (SIC) 有效预测经过透气管大动脉置换 (TAVR) 的严重大动脉狭窄患者的中期死亡率. 高SIC表明TAVR后的脆弱性增加,心脏损伤和死亡风险增加.
科学领域:
- 心脏病学 心脏病学
- 医学诊断 医学诊断 医学诊断
- 预测生物标志物 预测生物标志物
背景情况:
- 冲击指数 (SI) 和其衍生品在心血管疾病中被认为具有预后价值.
- 严重的大动脉狭窄症 (AS) 管理通常涉及跨导管大动脉置换 (TAVR).
研究的目的:
- 评估冲击指数肌素 (SIC) 对中期死亡率的预测能力,在接受TAVR的严重AS患者中.
- 评估SIC与患者特征,并发症和术后并发症之间的关联.
主要方法:
- 对555名接受TAVR治疗的严重AS患者进行了回顾性分析.
- 计算SIC: (SI × 100) - 估计的肌素清除率 (CCr).
- 主要终点:全因死亡率;次要终点:VARC-3并发症;统计分析:ROC曲线,Cox回归,受限立方脊线 (RCS).
主要成果:
- 高SIC (截止值16.5) 与显著更高的累积全因死亡率 (18.3%与5.2%,p < 0.001) 相关.
- 患有高SIC的患者年龄较大,身体较脆弱,并且中度/严重的甲骨管吐,三管吐和肺高血压的比率较高.
- 高SIC与急性损伤 (10.1%对3.9%,p=0.008) 和出血 (13.6%对6.7%,p=0.014) 的增加相关.
- RCS证实了SIC和死亡率之间的正相关性;结合SIC改善了STS得分对1年死亡率的预测值 (AUC0.731对0.649,p=0.01).
结论:
- 在接受TAVR治疗的严重AS患者中,SIC升高意味着脆弱性增加,心脏损伤增加,以及住院和中期死亡风险增加.
- 在TAVR候选人中,SIC是完善风险分层的一个有价值的工具.
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