术前左心室质量对对主动脉替换为主动脉反后的结果的影响
Kohei Hachiro1, Noriyuki Takashima1, Kenichi Kamiya1
1Division of Cardiovascular Surgery, Department of Surgery, Shiga University of Medical Science.
概括
左心室质量指数 (LVMI) 超过200g/m2预测在大动脉回置术后发生重大心脏和脑血管不良事件 (MACCE) 的风险更高.
科学领域:
- 心脏病学 心脏病学
- 心脏外科手术 心脏外科手术
- 心血管成像 - 心血管成像
背景情况:
- 大动脉反 (AR) 需要大动脉置换 (AVR).
- 左心室质量指数 (LVMI) 是心脏重塑的一个关键指标.
- 在AR的AVR中LVMI的预后值需要进一步阐明.
研究的目的:
- 为了确定最佳的LVMI切断值来预测 AR AVR 患者的主要心脏和脑血管不良事件 (MACCE).
- 评估手术前左心室改造对长期术后结果的影响.
主要方法:
- 对263名接受AR手术AVR的患者进行了回顾性分析.
- 接收器操作特征 (ROC) 曲线分析以确定LVMI截止值.
- 治疗权重的反向概率 (IPTW) 调整为术前特征.
主要成果:
- 对MACCE预测的最佳手术前LVMI截止值被确定为200g/m2 (AUC=0.692).
- 患有LVMI>200g/m2 (n=92) 的患者,与患有LVMI ≤200g/m2 (n=171,13.5%;P=0.020) 的患者相比,其10年MACCE率显著更高 (25.6%).
- 手术前的LVMI>200g/m2独立地与增加的MACCE风险相关 (HR 2.356;P=0.006).
结论:
- 术前超过200g/m2的LVMI是ARAVR患者中MACCE的显著预测指标.
- 升高的LVMI表明左心室重塑显著,与AVR后的较差的长期预后有关.
- 应将LVMI测量纳入AR患者进行AVR的风险分层.
相关概念视频
01:15Aortic Regurgitation I: Introduction
3
IntroductionAortic regurgitation is characterized by the backward flow of blood from the aorta into the left ventricle during diastole and arises from the improper closure of the aortic valve. This condition results in left ventricular volume overload and can stem from both acute and chronic etiologies, each contributing uniquely to the disease's progression and symptomatology.Acute and Chronic CausesAcute aortic regurgitation often results from events that suddenly impair the integrity of the...
3
01:17Aortic Regurgitation IV: Nursing Management
14
A nurse managing a patient with aortic regurgitation begins with a comprehensive assessment, including a review of the patient's medical history, family history, and lifestyle factors. During the cardiac examination, the nurse listens for heart sounds and checks for signs of valve abnormalities. The nurse also observes for symptoms such as dyspnea, orthopnea, and paroxysmal nocturnal dyspnea and assesses the patient's endurance and daily activity tolerance.Based on the findings, the nurse...
14
01:20Mitral Regurgitation I: Introduction
4
Mitral regurgitation is characterized by the backward circulation of blood from the left ventricle to the left atrium during systole, a phase of the cardiac cycle when the heart contracts and pumps blood out of the chambers. This abnormal flow occurs primarily due to the dysfunction of the mitral valve or its supporting structures, which include the mitral leaflets, chordae tendineae, annulus, and papillary muscles.Etiology and Mechanisms:Primary Mitral Regurgitation: This type arises from...
4
01:25Mitral Regurgitation III: Medical Management
4
Mitral regurgitation (MR) is characterized by retrograde blood circulation from the left ventricle into the left atrium due to inadequate mitral valve closure. The severity of the condition, symptoms, and underlying cause determine treatment strategies.Monitoring and Pharmacological TreatmentPatients with mild to moderate MR typically do not need immediate intervention but regular monitoring to assess progression and guide treatment. Patients with mild MR should have an echocardiogram every 3-5...
4
01:22Mitral Stenosis I: Introduction
2
Mitral Valve Stenosis (MVS) is a heart condition where the mitral valve narrows, impeding blood circulation from the left atrium to the left ventricle. The etiology and pathophysiology of this condition are multifaceted, leading to a cascade of cardiovascular complications.Causes of Mitral Valve StenosisRheumatic Heart Disease: It is the main cause of mitral valve stenosis, particularly in developing nations. This condition arises from rheumatic fever, an inflammatory illness resulting from...
2
01:28Cardiomyopathy VII: Pre and Post Operative Nursing Management
3
Patients with hypertrophic cardiomyopathy (HCM) and left ventricular outflow tract (LVOT) obstruction who remain symptomatic despite optimal medical therapy may undergo a septal myectomy (Morrow procedure). This procedure involves excising a portion of the hypertrophied septum below the aortic valve using a heart-lung machine to improve blood flow through the LVOT. Effective preoperative and postoperative nursing management ensures successful patient outcomes, minimizes complications, and...
3