胸前大动脉动脉瘤和心血管死亡率的特定位置分析:来自澳大利亚国家回声数据库的见解
James Nadel1, Avan Suinesiaputra2, Elizabeth D Paratz3
1School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; Clinical Research Group, Heart Research Institute, Newtown, Australia; Cardiology Department, St. Vincent's Hospital, Darlinghurst, Australia.
概括
严重的胸前动脉动脉瘤 (TAA) 显著增加心血管疾病 (CVD) 死亡风险. 上升性大动脉扩张比大动脉根动脉瘤具有更高的心血管疾病风险,为未来的风险分层和外科管理提供信息.
科学领域:
- 心脏病学 心脏病学
- 血管外科 血管外科
- 公共卫生 公共卫生
背景情况:
- 大动脉直径是胸前大动脉动脉瘤 (TAA) 手术纠正的主要标准.
- 目前的指导方针并没有根据动脉瘤位置 (根与上升大动脉) 区分TAA管理.
- 了解特定地点TAA对心血管疾病 (CVD) 死亡率的影响对于改善临床实践至关重要.
研究的目的:
- 研究不同部位的胸前动脉动脉瘤 (TAA) 尺寸与心血管疾病 (CVD) 死亡率之间的关联.
- 确定上升性大动脉动脉瘤大小是否影响心血管疾病死亡风险不同于大动脉根动脉瘤大小.
主要方法:
- 利用澳大利亚国家回声数据库 (NEDA) 与国家死亡指数相关联.
- 根据Valsalva鼻,鼻管结和上升大动脉 (AscAo) 的大动脉直径分层的患者.
- 将大动脉尺寸分为正常 (<4厘米) 和扩张类别 (轻度,中度,严重).
主要成果:
- 任何部位的严重TAA增加了10年心血管疾病死亡风险 (31%对14%,P<.0001).
- 心血管疾病死亡风险从大动脉根到上升的大动脉逐渐增加.
- 上升的大动脉扩张显示了最高的心血管疾病死亡风险 (45%,HR 3.96,P <.001).
结论:
- 严重的TAA增加了心血管疾病死亡的可能性.
- 上升的大动脉扩张比大动脉根动脉瘤具有更高的心血管疾病死亡风险.
- 结果表明,对上升大动脉动脉瘤的风险分层和手术管理考虑进行了修订.
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