评估和管理左侧传染性内心炎的栓塞风险
J Alberto San Román1, Teresa Sevilla1, Gonzalo Cabezón1
1Cardiology Department, Institute of Heart Sciences (ICICOR), Valladolid, Spain; Centro de investigación biomédica en red Cardiovascular (CIBERCV), Madrid, Spain; Instituto de investigación biomédica de Valladolid (IBioVALL), Valladolid, Spain.
The Canadian journal of cardiology
|October 30, 2025
概括
左侧传染性内心炎具有较高的死亡风险. 这次审查建议评估超出大小的植被特征,以预测栓塞事件并指导手术决策.
科学领域:
- 心脏病学 心脏病学
- 传染性疾病 传染性疾病
- 血管外科 血管外科
背景情况:
- 左侧感染性内心炎 (IE) 的死亡率很高 (20-30%),超过许多癌症的死亡率.
- 在IE中的植被容易发生栓塞,导致栓塞事件 (EE) 并显著增加死亡率,特别是在引起中风时.
研究的目的:
- 审查传染性内心炎中栓塞事件的流行病学,风险因素,诊断和管理.
- 建议从以大小为中心的方法转向植被评估,以预测EE风险.
- 突出外科手术在预防EE中的作用,并讨论新兴的创新.
主要方法:
- 综合文献综述,重点关注传染性内心炎,植被和栓塞事件.
- 分析当前关于EE预防手术指示的指导方针和证据.
- 探索新的诊断和治疗策略,包括人工智能.
主要成果:
- 目前的指南建议基于植被的存在和大小来预防EE的手术,但仅仅支持大小的证据是微弱的.
- 除了尺寸之外的植被特征,与临床和微生物因素一起,是EE风险的关键决定因素.
- 手术仍然是预防IE栓塞事件的关键干预措施.
结论:
- 考虑植被形态,临床表现和微生物学的多因素方法在评估EE风险时优于单独的尺寸.
- 修订当前的指导方针以纳入这些更广泛的因素可能会优化手术决策并改善患者的治疗结果.
- 未来的方向包括利用人工智能和最小侵入性技术来管理IE.
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