转导管大动脉置换后严重大动脉狭窄患者的后负荷和收缩能力的变化
Kristian B Laursen1,2, Rasmus Carter-Storch1, Patricia A Pellikka3
1Department of Cardiology, Cardiovascular Research Unit, Odense University Hospital, 5000 Odense, Denmark.
European heart journal. Imaging methods and practice
|June 9, 2025
概括
在大动脉狭窄时,左心室喷射率 (LVEF) 修正为末缩壁应力 (ESWS) 增加过导管大动脉置换后 (TAVR). 这表明LVEF/ESWS是负载依赖的,尽管TAVR之后ESWS显著下降.
科学领域:
- 心脏病学 心脏病学
- 心血管外科心血管外科
- 生物医学工程 生物医学工程
背景情况:
- 在大动脉狭窄 (AS) 中评估左心室 (LV) 收缩性是具有挑战性的,因为大多数静脉功能标志物的负载依赖性.
- 脊椎外射分数 (LVEF) 与末性壁应力 (ESWS) 的比率是收缩性的公认标志物.
- 负载条件对LVEF/ESWS比率的影响以前没有研究过.
研究的目的:
- 为了评估ESWS和ESWS纠正的LVEF在重症AS患者的跨导管大动脉置换 (TAVR) 后发生的变化.
- 为了确定ESWS和ESWS纠正的LVEF是否受到TAVR后变化的负载条件的影响.
主要方法:
- 一项前性研究涉及41名患有严重AS的患者接受TAVR.
- 在TAVR之前和之后立即进行心声学,LV导管和计算机断层扫描 (CT).
- 使用三个方法估计ESWS:仅使用心声回声 (ESWSEcho),CT LV尺寸与心声回声梯度 (ESWSCT+echo),CT LV尺寸与侵入性LV末压 (ESWSCT+Invasive).
主要成果:
- 所有三种ESWS估计方法都显示TAVR后显著下降 (P < 0.01).
- 在不同的ESWS测量技术之间观察到弱到中等的关联.
- 在TAVR后的所有方法中,ESWS校正的LVEF显著增加 (P<0.01),表明独立于后载的收缩性得到改善.
结论:
- 在TAVR之后ESWS的显著减少表明它反映了后载.
- 在TAVR后的ESWS校正的LVEF中观察到的增加表明该比率是负载依赖的.
- 这些发现强调了在解释AS患者的LV收缩性标记时考虑负载条件的重要性.
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