患者的临床结局 四柱与双柱大动脉
Jingnan Zhang1,2, Fang Fang3, Zhiyuan Xia3
1Division of Cardiology, Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.
JAMA network open
|August 4, 2025
概括
四大动脉 (QAV) 和双大动脉 (BAV) 都需要进行干预. QAV增加了心力衰竭住院的风险,而BAV与传染性内心炎和大动脉手术有关,尽管两种情况的存活率相似.
科学领域:
- 心血管医学 心血管医学
- 遗传性心脏病是一种先天性心脏病.
- 膜心脏疾病 膜心脏疾病
背景情况:
- 先天性大动脉病很常见,双管大动脉 (BAV) 是最常见的类型.
- 四柱动脉 (QAV) 是一种罕见的先天性异常,与BAV相比,其临床结果尚未得到充分确立.
- 了解QAV和BAV的不同临床轨迹对于患者管理和风险分层至关重要.
研究的目的:
- 为了比较被诊断为四主动脉 (QAV) 和双主动脉 (BAV) 的患者之间的临床结果.
- 调查QAV和BAV队列之间的大动脉干预,大动脉手术,大动脉剖析,传染性内心炎,心力衰竭住院和全因死亡率的差异.
- 评估QAV与BAV患者的长期存活率相对于一般人群.
主要方法:
- 在2011年1月1日至2023年12月31日期间,在中国的两家三级医院使用心声学数据进行了一项回顾性队列研究.
- 确定了被诊断为QAV或BAV的患者,根据年龄和性别,QAV患者的倾向性得分与BAV患者的倾向性得分相匹配1:5.
- 包括大动脉干预,大动脉手术,大动脉剖析,传染性内心炎 (IE),心力衰竭住院治疗 (HFH) 和全因死亡在内的结果使用累积发病率函数和多变量调整进行了分析.
主要成果:
- 这项研究包括139名QAV患者和695名BAV患者,随访时间平均为4.8年.
- 无论是QAV和BAV队伍,都显示出类似的大动脉干预率 (77.4%与75.7%).
- 与BAV患者相比,QAV患者的大动脉手术 (5.1%与33.8%) 和IE (0%与9.6%) 的发病率较低,但高血压风险 (调整后危险比率[AHR],2.52) 的风险较高. 心肌病是QAV患者中HFH的独立预测因子 (AHR,4.27).
- 在这两组中,大动脉剖析是罕见的. 对于QAV (102.9%) 和BAV (102.4%),5年相对存活率与一般人群相比较.
结论:
- 无论是QAV还是BAV,都与对大动脉干预的高度需求有关.
- QAV与心力衰竭住院的风险增加有关,而BAV与传染性内心炎和大动脉手术的更高率有关.
- 尽管患病率很高,但QAV或BAV患者的长期存活率与普通人群的长期存活率相似.
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