在接受TAVI治疗的患者中,侵袭性与心声谱衍生的大动脉梯度的预后值
Mark M P van den Dorpel1, Sraman Chatterjee1, Rik Adrichem1
1Department of Cardiology, Cardiovascular Institute, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands.
概括
在TAVI后的侵入性大动脉梯度预测死亡率,与回声衍生的不同. 心声学高估了梯度,特别是在气球扩展 (BEV) 与自扩展 (SEV) 之间.
科学领域:
- 心血管医学 心血管医学
- 干预心脏病学 干预心脏病学
- 人造心脏门是一种假心脏门.
背景情况:
- 在透气管大动脉植入后 (TAVI) 侵袭性和回声心脏学衍生的梯度之间的不一致性,在气球可扩展 (BEV) 和自扩展 (SEV) 中被注意到.
- 关于TAVI后这种梯度不一致的决定因素和临床影响的数据有限.
研究的目的:
- 评估SEV和BEV植入后侵袭性和心声谱衍生的梯度的预后意义.
- 为了比较SEV和BEV之间的跨膜梯度.
主要方法:
- 追溯性,倾向性得分匹配研究,涉及436对匹配的SAPIEN 3 (BEV) 和Evolut (SEV) 门.
- 在TAVI前和之后进行了侵袭性和回声心脏图谱梯度测量,并在1年后重复回声心脏图谱.
- 临床结局 (全因死亡率) 被评估为30天,1年,2年.
主要成果:
- 侵袭性TAVI后梯度独立预测了30天,1年和2年后更高的全因死亡率.
- 心声谱衍生的梯度没有显示出死亡率的预后价值.
- 通过回声心脏图比侵入性评估,平均梯度更高,BEV与SEV的不一致性更大;较小的门尺寸,更高的射出分数和更高的中风体积放大了这一差异.
结论:
- 只有侵入性测量的跨膜平均梯度,而不是来自心声谱的梯度,与TAVI后的死亡结果相关.
- 与侵入性测量相比,心声学高估了大动脉梯度,特别是在BEV与SEV相比.
- 诸如较小的门尺寸,较高的射出率和较高的中风体积等因素有助于回声心脏图-侵入性梯度不一致.
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