在低流量,低梯度的大动脉狭窄症中,TAVI后的长期存活率
Francesco Cardaioli1, Luca Nai Fovino1, Tommaso Fabris1
1Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua Medical School, Padua, Italy.
概括
经典的低流量,低梯度 (LFLG) 大动脉狭窄患者在通过导管大动脉植入 (TAVI) 后的存活率更差. 然而,低流状态本身没有影响TAVI后的长期死亡率,LVEF恢复改善了结果.
科学领域:
- 心脏病学 心脏病学
- 干预心脏病学 干预心脏病学
- 心脏外科手术 心脏外科手术
背景情况:
- 过导管大动脉植入 (TAVI) 是大动脉狭窄症 (AS) 的关键治疗方法.
- 低流量,低梯度 (LFLG) AS带来了独特的挑战,经典的LFLG (cLFLG) 与更高的短期死亡率有关.
- 悖论性LFLG (pLFLG) AS也需要对预后进行仔细考虑.
研究的目的:
- 为了比较TAVI患者的长期存活率,cLFLG-AS,pLFLG-AS和高梯度AS (HG-AS).
- 为了确定低流状态是否独立地影响TAVI后的长期死亡率.
- 评估TAVI后左心室喷射分数 (LVEF) 恢复对生存的影响.
主要方法:
- 对574名TAVI患者进行了回顾性分析,随访时间至少为5年.
- 患者分为HG-AS (平均梯度> 40 mmHg),cLFLG-AS (梯度< 40 mmHg,EF < 50%) 和pLFLG-AS (梯度< 40 mmHg,EF ≥ 50%) 的患者.
- 倾向性得分加权生存分析以调整基线混因子;主要终点是全因死亡率.
主要成果:
- 经典LFLG-AS患者表现出最高的基线心血管风险和最差的未调整的长期预后.
- 未经调整的分析显示,cLFLG-AS的生存率明显低于pLFLG-AS和HG-AS (p=0.023).
- 权重分析显示cLFLG-AS和HG-AS的存活率相似;基线EF没有预测,但TAVI后LVEF改善>10%与更长的存活率相关 (p=0.02).
结论:
- 与pLFLG-AS和HG-AS相比,经典的LFLG-AS与TAVI后的长期存活率较低有关.
- 在对混因素进行调整后,仅仅低流量状态并没有显著影响TAVI后的长期死亡率.
- 在TAVI后恢复LVEF是改善长期生存的重要预测因素.
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