在米特拉修复前后,左心室大小和功能的性别差异
Christian E Berg-Hansen1, Nina Ajmone Marsan2, Robert J M Klautz3
1Department of Heart Disease, Haukeland University Hospital, Bergen, Norway;; Department of Clinical Science, University of Bergen, Bergen, Norway;; Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
概括
患有 mitra valve prolapse (MVP) 并且正在进行 mitra valve repair (MVr) 的女性在手术后出现左心室 (LV) 扩张和功能障碍的比率更高. 这表明需要在MVR之前对LV大小进行性别特定的评估,以改善患者的治疗结果.
科学领域:
- 心血管医学 心血管医学
- 心脏外科手术 心脏外科手术
- 心脏病学 心脏病学
背景情况:
- 健康的女性比男性表现出较小的心脏大小和较高的左心室 (LV) 喷射率 (EF) 和全球纵向应变 (GLS),即使在身体表面积 (BSA) 索引后.
- 在接受米特拉修复 (MVr) 的米特拉脱落 (MVP) 患者中,LV重塑的性别差异尚不清楚.
研究的目的:
- 调查MVP患者进行MVR的LV大小和功能中的术前和术后的性别差异.
主要方法:
- 对190名MVP患者 (2007-2024) 进行MVR的回顾性分析,不包括先前手术,冠状动脉疾病或显著的残留腹病患者.
- 在MVr前和之后,使用性别特定的值评估了LV大小 (末直径/体积,ESV) 和功能 (EF,GLS).
- 主要结局:手术后 LV 损伤 (扩大 LV 末缩体积指数 [ESVi],受损 EF 或受损 GLS).
主要成果:
- 在手术前,男性的 LV 末缩体积 (ESV) 较大,而女性的 BSA 调整后的 LV 末缩直径 (ESD) 较高.
- 在术后,只有男性的LVESV显著减少. 女性患 LV 扩张的可能性是 6.3 倍,患 LV GLS 损伤的可能性是 3.3 倍.
- 两性之间LV EF仍然相似,但女性的手术前LV GLS更高. 预测术后损伤的最佳LV ESD/BSA切线因性别而异.
结论:
- 与男性相比,接受MVr的MVP女性经历了术后LV扩张和功能障碍的更高率.
- 研究结果表明,女性可能在疾病晚期进行手术,这突显了需要进行性别特定的手术前 LV 尺寸评估的必要性.
- 建议根据性别特异性LV参数量身定制的外科转诊标准,以优化MVP患者的治疗结果.
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