定义Fontan后的透缩功能障碍:门,危险因素和与结果的关联
Tarek Alsaied1, Runjia Li2, Haley Grant2
1Heart Institute, UPMC Children's Hospital of Pittsburgh, Department of Pediatrics, Division of Cardiology, University of Pittsburgh School of Medicine, Pittsburgh, PA.
American heart journal
|July 12, 2025
概括
在Fontan手术后的腹功能障碍 (DD),以升高的末端腹压力 (EDP) >13 mm Hg表示,显著增加了不良结果. 风险因素包括年龄较大,BMI较高和非左心室形态.
科学领域:
- 心脏病学 心脏病学
- 儿童心脏病学 儿童心脏病学
- 遗传性心脏病是一种先天性心脏病.
背景情况:
- 在Fontan手术后单心室生理病患者面临扩张功能障碍 (DD) 和末端扩张压力 (EDP) 的高风险.
- 早期识别和管理DD对于改善这一群体的长期结果至关重要.
研究的目的:
- 为了确定最佳的EDP值,表明Fontan程序后的不良结果.
- 确定与Fontan患者DD发展相关的临床和成像预测因素.
主要方法:
- 使用心脏磁共振检查 (FORCE) 来利用Fontan结果注册表的数据.
- 包括在两年窗口内接受心脏导管和心脏磁共振 (CMR) 的患者.
- 定义了一个复合的结局,包括死亡率,心律失常,塑性支气管炎,蛋白质丧失肠病或移植列表.
主要成果:
- 分析了861名患者 (平均年龄为16.4±9.3岁);DD被定义为最佳EDP值>13mmHg.
- 扩张性功能障碍 (DD) 存在于11.3%的患者中,并与3倍以上的不良结果风险增加有关 (HR 3.37).
- 预测DD的预测因素包括导管时的年龄较大,更高的BMI,非左心室形态和更大的心室终端透缩体积 (EDV).
结论:
- 升高的EDP>13 mm Hg表示腹功能障碍 (DD),并且与Fontan后不良结果的风险显著增加有关.
- 年龄较大,BMI较高,非左心室形态和EDV增加是DD的关键危险因素.
- 具有危险因素的患者的查导管可能有助于早期DD检测和量身定制的管理策略.
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