右侧额外膜损伤:一个被忽视的风险模型失败的驱动器在低流量,低梯度的大动脉狭窄症中
Yash Prakash1, Akarsh Sharma1, Lakshay Chopra2
1Samuel Bronfman Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
Journal of the Society for Cardiovascular Angiography & Interventions
|February 23, 2026
概括
右侧额外膜损伤标志物改善了TAVR后在低流量,低梯度大动脉狭窄 (AS) 的死亡率预测. 这些标志物精确了STS-PROM得分,特别是在中度风险患者中,提高了患者对TAVR的选择.
科学领域:
- 心脏病学 心脏病学
- 心脏外科手术 心脏外科手术
- 医疗成像医学成像
背景情况:
- 胸腔外科医生协会预测死亡风险 (STS-PROM) 评分用于大动脉狭窄 (AS) 的程序风险.
- STS-PROM倾向于高估长期死亡率的跨导管大动脉置换后 (TAVR).
研究的目的:
- 评估右侧额外膜损伤标志物是否可以改善STS-PROM在预测TAVR后1年死亡率方面的表现.
- 专注于患有低流量,低梯度AS的患者.
主要方法:
- 对410名接受TAVR治疗的患者进行回顾性分析,以研究低流量,低梯度的AS.
- 分为STS-PROM风险组的分层 (低,中等,高).
- 评估了一个增强的模型,包括STS-PROM和右侧额外膜损伤标志物 (肺高血压,三回,RV功能障碍).
主要成果:
- 右侧额外膜损伤独立地与1年死亡率的增加有关 (OR 2.45).
- 改进模型显示了更好的适应 (Δχ2 = 8.68,P < .01) 和歧视 (IDI = 0.02,P = .01).
- 改善了幸存者分类 (非事件NRI = 0.10,P < .01),在中度风险患者中获得的最大收益.
结论:
- 右侧的额外膜损伤标记在低流量,低梯度的AS中提供预后价值.
- 这些标志物纠正了STS-PROM对TAVR后死亡率的高估.
- 附加值在中度风险患者中最为显著,可能改善TAVR选择.
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