在接受左心室辅助装置植入的患者中,非侵入性心肌工作测量的临床含义
Ahmad Alofesh1,2, Ahmad Abugameh3,4, Leyla Dogan1
1Department of Cardiac Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074, Aachen, Germany.
概括
手术前的非侵入性心肌工作指数预测了接受左心室辅助器件 (LVAD) 植入心力衰竭患者的结果. 较低的全球工作指数预测死亡率,而密歇根州的右心力衰竭得分预测右心力衰竭.
科学领域:
- 心脏病学 心脏病学
- 生物医学工程 生物医学工程
- 医学诊断 医学诊断 医学诊断
背景情况:
- 非侵入性心肌工作评估整合了心肌变形和后负荷,以改善左心室 (LV) 功能评估.
- 左心室辅助装置 (LVAD) 植入是晚期心力衰竭的关键干预措施.
- 在LVAD接受者中预测术后结果仍然是一个重大的临床挑战.
研究的目的:
- 评估术前心肌工作指数对经久久LVAD植入心力衰竭患者术后结果的预测能力.
- 为了确定非侵入性心肌工作指数是否能改善风险分层,超出已建立的临床分数.
- 确定术后右心力衰竭 (RHF) 和死亡率的预测因素.
主要方法:
- 追溯队列研究涉及53名接受LVAD植入的心力衰竭患者.
- 胸前回声心电图 (TTE) 与同时进行非侵入性血压测量以获得LV全球工作指数 (GWI).
- 计算已确定的临床风险得分 (HMRS,HM3RS,EuroSCORE II,MRHFS,EUROMACS-RHF) 和后勤回归分析以预测结果.
主要成果:
- 较低的手术前LV-GWI独立预测了长期死亡率 (每1mmHg调整的OR为0.98;p=0.002),具有很高的歧视性 (明显AUC≈0.90).
- 密歇根右心力衰竭评分 (MRHFS) 是术后RHF最强的独立预测因子 (OR每1SD2.80; p=0.001;明显AUC ≈0.90).
- 传统的TTE指数没有预测经过调整后的结果.
结论:
- 术前非侵入性全球左心室肌动脉工作指数提高了LVAD接受者死亡率的预测,超过了既定的风险得分.
- 密歇根右心力衰竭得分有效地识别了患有术后右心室衰竭风险的患者.
- 心肌工作指数为接受LVAD治疗的晚期心力衰竭患者的管理提供了有价值的预后信息.
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