严重的大动脉狭窄和左心室缩的无症状个体中的大动脉置换和死亡率
Jason H Wasfy1, Muhammad Etiwy2, Yunong Zhao1
1Heart and Vascular Institute and Department of Medicine, Mass General Brigham, Harvard Medical School, 55 Fruit Street, Boston, Massachusetts, 02138, USA.
概括
在严重无症状的大动脉狭窄症 (AS) 中,大动脉置换 (AVR) 与保存的射出分数和左心室缩 (LVH) 相关,导致死亡率降低. 这一发现表明这些患者应该考虑更早的AVR.
科学领域:
- 心血管医学
- 心脏外科
- 心声检查
背景情况:
- 在严重无症状的大动脉狭窄症 (AS) 中,对大动脉置换 (AVR) 的指示因左心室喷射率 (LVEF) 而异.
- 左心室缩 (LVH) 可能表明心室损伤,并表明需要更早的AVR,即使保存LVEF.
研究的目的:
- 调查AVR与严重无症状AS,保存LVEF和LVH患者的死亡率之间的关联.
- 评估LVH作为在无症状严重AS中优先干预的潜在标志物.
主要方法:
- 使用自然语言处理对超过120万个心声回声报告来识别AS,LVEF和LVH.
- 将心声学数据与死亡率和AVR记录联系起来,然后进行手动图表检查以确认.
- 使用Cox的比例风险模型来评估AVR与死亡率之间的时间依赖关系.
主要成果:
- 这项研究包括607名确诊无症状的严重AS,保存LVEF (≥55%) 和LVH患者.
- 在对时间依赖治疗状态进行调整后,AVR与降低死亡率 (危险率0. 37;P < 0. 0001) 有关.
结论:
- 在严重无症状AS,保存LVEF和LVH的患者中,AVR与较低的死亡率有关.
- 在无症状的严重AS患者中,LVH是一种易于评估的标志物,可帮助确定AVR的优先级.
- 这些发现支持在没有症状的LVH和严重AS患者中考虑更积极的AVR.
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