在无症状大动脉吐中早期左心室功能障碍的心声标记:是时候改变指南了吗?
Vidhu Anand1, Hector I Michelena1, Christopher G Scott2
1Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
JACC. Cardiovascular imaging
|November 15, 2024
概括
对于无症状的慢性大动脉反,早期的LV功能障碍标志物如LVEF,iESV和GLS预测死亡率. 两个或两个以上的标志物,缺少指导方针建议,识别高风险患者,他们可能受益于及时进行大动脉置换手术.
科学领域:
- 心脏病学 心脏病学
- 心脏外科手术 心脏外科手术
- 心声回声扫描 (Echocardiography) 是一种心声回声扫描.
- 心血管成像 - 心血管成像
背景情况:
- 对于无症状慢性大动脉反 (AR) 的最佳手术时间仍在争论中.
- 左心室 (LV) 功能障碍标志物,包括喷射分数 (LVEF),索引末缩体积 (iESV) 和全球纵向应变 (GLS),是新出现的风险指标.
- 这些标志物可能意味着在具有显著AR的患者中早期的LV功能障碍.
研究的目的:
- 为了评估LVEF<60%,iESV≥45mL/m2和GLS低于-15%与无症状慢性AR的死亡率之间的关联.
- 为了比较这些LV功能障碍标志物的预测值与当前ACC/AHA指南对大动脉干预的建议.
- 确定可能从早期手术干预中受益的高风险患者子组.
主要方法:
- 追溯分析673个无症状患者的慢性,临床显著 (≥中度至重度) AR.
- 2004年至2019年间从单个推中心收集的数据.
- 主要结局是全因死亡率;分析包括LVEF,iESV,GLS的评估,以及遵守指南建议.
主要成果:
- 在符合I/IIa类指南建议的患者 (HR:4.22) 和具有一个或多个LV功能障碍标志物 (HR:2.18) 的患者中,全因死亡率显著更高.
- LVEF <60%是死亡率最强的预测因素,紧随其后的是GLS和iESV.
- 在没有指南建议的患者中,两个或两个以上的LV功能障碍标志物的存在与显著增加的死亡率有关 (HR:5.46),特别是当所有三个标志物都存在时.
结论:
- 无症状患者具有显著的慢性AR面临增加的死亡风险在满足Class I/IIa手术指南标准.
- 由于没有指导性适应症,至少有两种LV功能障碍标志物 (LVEF,iESV,GLS) 的存在可以确定患病风险较高的患者.
- 这些发现表明,早期手术干预可能对患有多个LV功能障碍标志物的患者有益,即使不达到目前的指导值.
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