左心房菌株对关节节律的风湿性心肌狭窄症中全身栓塞的预后价值:对抗凝血策略的影响
Iksung Cho1, Seonhwa Lee2, In-Cheol Kim3
1Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea.
概括
患有鼻节律 (SR) 的风湿性额狭窄症 (MS) 患者的全身栓塞风险与左心房 (LA) 应变受损有关. 下LA储菌株 (LASr) 预测血栓事件,建议针对高风险个体提供向抗凝剂.
科学领域:
- 心脏病学 心脏病学
- 心血管医学 心血管医学
- 类风湿病学 类风湿病学
背景情况:
- 风湿性额头狭窄症 (MS) 构成中风和全身栓塞的重大风险,即使在维持鼻节律 (SR) 的患者中也是如此.
- 确定这些栓塞事件的预测因素对于有效的患者管理至关重要.
研究的目的:
- 确定SR的风湿性MS患者中风和全身栓塞的危险因素.
- 评估左心房 (LA) 机制的预测值,特别是LA菌株,用于栓塞事件.
主要方法:
- 对875名风湿性MS和SR患者的分析.
- 在96.4个月的平均随访期间评估系统性栓塞事件 (中风,暂时性缺血性发作,非中枢神经系统栓塞).
- 评估左心室储压力 (LASr) 和其与栓塞事件的相关性,调整以考虑混因素.
主要成果:
- 系统性栓塞事件发生在14.1%的患者中.
- 损坏的LASr与更高的全身栓塞事件发生率 (14.4 ± 5.3%与18.8 ± 6.8%,P <.001) 有显著的关联.
- LASr是栓塞事件的独立预测因子 (HR,0.84;P = .001),截止值为16.6%,识别了高风险子组.
结论:
- 损坏的LA菌株是性MS和SR患者全身栓塞的重要危险因素.
- 左心房储应变测量可以帮助分层栓塞风险.
- 有针对性的抗凝策略可能有利于LA菌株受损的患者.
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