动脉狭窄症:一个综述
Catherine M Otto1, David E Newby2, Graham S Hillis3
1Division of Cardiology, University of Washington School of Medicine, Seattle.
JAMA
|November 11, 2024
概括
动脉狭窄 (AS) 是一种影响老年人的渐进性疾病. 在症状严重的AS患者中,通过手术更换大动脉或通过导管植入大动脉治疗显著降低了死亡率.
科学领域:
- 心脏病学
- 老年病学
- 心脏膜疾病
背景情况:
- 动脉狭窄症 (AS) 是65岁以上成年人的常见病症,其特征是动脉的化和纤维化.
- 在美国,65岁以上的成年人中有1-2%和75岁以上的成年人中有12%患有这种疾病,每年导致全球超过10万人死亡.
- 甲状腺炎涉及脂质透,炎症,纤维化和大动脉片的化,限制了血液流动.
研究的目的:
- 审查动脉狭窄的诊断,治疗和治疗选择.
- 强调对症状严重的AS及时干预的重要性.
- 讨论手术性主动脉置换 (SAVR) 和跨导管主动脉植入 (TAVI) 的比较结果和指导方针.
主要方法:
- 用心声扫描检测AS并评估其严重程度.
- 治疗包括患者教育,定期临床和心声监测以及风险因素修改 (高血压,高脂血症,吸烟).
- 症状严重的AS的治疗包括SAVR或TAVI.
主要成果:
- 严重的AS被定义为大动脉速度≥4 m/s,平均梯度≥40 mm Hg,或膜面积≤1.0 cm2.
- 在没有干预的情况下,症状严重的AS死亡率高达50%.
- 在老年低风险患者中,SAVR和TAVI恢复了平均预期寿命,可比10年全因死亡率 (TAVI: 62. 7%,SAVR: 64. 0%). 医院住院时间更短,恢复速度更快.
结论:
- 性AS是一种通过心声扫描诊断的渐进性疾病,严重的症状病例的死亡率很高.
- 在症状严重的AS患者中,SAVR或TAVI显著降低了死亡率,使预期寿命正常化.
- 治疗决策应以基于证据的指导方针,共享决策和多学科的心脏组为指导.
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