JAHA:经导管二尖瓣修补术后血流动力学成功的二尖瓣解剖预测因素!

2018-01-14 xing.T MedSci原创

由此可见,二尖瓣的病理解剖学特征,是TMVR后最佳LAP降低的预测因素。高质量三维成像可以帮助选择经TMVR治疗后血流动力学结局达到最优的患者。

二尖瓣返流是一种异质性疾病。确定哪些患者可以从经导管边缘到边缘二尖瓣修复术(TMVR)中获得最佳的结局仍具挑战性。近日,心血管疾病领域权威杂志JAHA上发表了一篇研究文章,研究人员试图明确基线二尖瓣解剖特性是否预测采用MitraClip进行TMVR期间左房压力(LAP)变化。

研究人员对接受TMVR的连续就诊的重度二尖瓣反流的患者(n=112)进行了术间连续LAP监测,并对特定的二尖瓣的解剖特点进行回顾性超声心动图分析。手术成功(最佳LAP减少)被定义为左心房V-波压力与基线相比降低超过40%。研究人员对最佳LAP减少和增加的术后平均舒张压差的超声心动图预测指标进行了评价。

参与者平均年龄为79±14岁,女性有36例(占32%)。原发性、混合性和继发性二尖瓣返流分别为78例(70%)、22例(20%)、12例(10%)。基线平均LAP和V-波分别为22±6和38±13mmHg;TMVR后,这些分别下降到19±5和27±10mmHg(P<0.0001)。最佳LAP降低的独立预测因子是连枷状瓣膜、二尖瓣返流局限于一个瓣膜以及高质量的三维超声心动图像。术后平均舒张压升高的独立预测因素为增加的术前平均舒张压、二尖瓣环钙化以及多个片段植入。

由此可见,二尖瓣的病理解剖学特征,是TMVR后最佳LAP降低的预测因素。高质量三维成像可以帮助选择经TMVR治疗后血流动力学结局达到最优的患者。

原始出处:

Jeremy J. Thaden,et al. Mitral Valve Anatomic Predictors of Hemodynamic Success With Transcatheter Mitral Valve Repair.JAHA.2018. https://doi.org/10.1161/JAHA.117.007315

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    2018-01-16 zhaohui6731
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    2018-01-16 wwzzly
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    2018-01-16 lsj631
  7. [GetPortalCommentsPageByObjectIdResponse(id=1812053, encodeId=c1c4181205391, content=<a href='/topic/show?id=d7a1891613d' target=_blank style='color:#2F92EE;'>#血流动力#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89161, encryptionId=d7a1891613d, topicName=血流动力)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=仁心济世, createdTime=Mon Jun 11 15:21:00 CST 2018, time=2018-06-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1264270, encodeId=1ff012642e098, content=<a href='/topic/show?id=daf1100226fb' target=_blank style='color:#2F92EE;'>#预测因素#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100226, encryptionId=daf1100226fb, topicName=预测因素)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a57b78, createdName=朱睿睿, createdTime=Tue Jan 16 01:21:00 CST 2018, time=2018-01-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1267689, encodeId=5fae126e68900, content=<a href='/topic/show?id=922f21183d' target=_blank style='color:#2F92EE;'>#AHA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2118, encryptionId=922f21183d, topicName=AHA)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bf3d82, createdName=zhaohui6731, createdTime=Tue Jan 16 01:21:00 CST 2018, time=2018-01-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1392003, encodeId=6b7a1392003f8, content=<a href='/topic/show?id=3704891621c' target=_blank style='color:#2F92EE;'>#血流动力学#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89162, encryptionId=3704891621c, topicName=血流动力学)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=99cf2500102, createdName=zjshifan_98647306, createdTime=Tue Jan 16 01:21:00 CST 2018, time=2018-01-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1463188, encodeId=78b6146318898, content=<a href='/topic/show?id=cff92389310' target=_blank style='color:#2F92EE;'>#二尖瓣#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23893, encryptionId=cff92389310, topicName=二尖瓣)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=fdb26536308, createdName=wwzzly, createdTime=Tue Jan 16 01:21:00 CST 2018, time=2018-01-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1510118, encodeId=f24f1510118ac, content=<a href='/topic/show?id=e9bce8254ef' target=_blank style='color:#2F92EE;'>#经导管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78254, encryptionId=e9bce8254ef, topicName=经导管)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=93e010191378, createdName=lsj631, createdTime=Tue Jan 16 01:21:00 CST 2018, time=2018-01-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=278414, encodeId=296f2e8414a0, content=学习了.谢谢., beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/xkvRjYnJzzRJ2R0y7VhicibvkjPWHjIMmu4ZpKnE9cWAu4lVicS3uDUCfF4M4JWvrkrYfpb2KehPV0Ee29tPqyPEebBUibiaKhnvD/0, createdBy=f8412001184, createdName=惠映实验室, createdTime=Sun Jan 14 11:01:15 CST 2018, time=2018-01-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=278406, encodeId=f20c2e84064f, content=学习了.谢谢谢分享., beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=60791943465, createdName=1e0f8808m18(暂无匿称), createdTime=Sun Jan 14 10:55:04 CST 2018, time=2018-01-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=278398, encodeId=21342e83989d, content=学习了.涨知识, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220115/46bcf39c32de4aa6b45c5f9d66c8ee77/6cb4a20c55bb4b7691122f47747bfca2.jpg, createdBy=9dad1662329, createdName=1ddf0692m34(暂无匿称), createdTime=Sun Jan 14 10:43:24 CST 2018, time=2018-01-14, status=1, ipAttribution=)]
    2018-01-14 惠映实验室

    学习了.谢谢.

    0

  8. [GetPortalCommentsPageByObjectIdResponse(id=1812053, encodeId=c1c4181205391, content=<a href='/topic/show?id=d7a1891613d' target=_blank style='color:#2F92EE;'>#血流动力#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89161, encryptionId=d7a1891613d, topicName=血流动力)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=仁心济世, createdTime=Mon Jun 11 15:21:00 CST 2018, time=2018-06-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1264270, encodeId=1ff012642e098, content=<a href='/topic/show?id=daf1100226fb' target=_blank style='color:#2F92EE;'>#预测因素#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100226, encryptionId=daf1100226fb, topicName=预测因素)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a57b78, createdName=朱睿睿, createdTime=Tue Jan 16 01:21:00 CST 2018, time=2018-01-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1267689, encodeId=5fae126e68900, content=<a href='/topic/show?id=922f21183d' target=_blank style='color:#2F92EE;'>#AHA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2118, encryptionId=922f21183d, topicName=AHA)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bf3d82, createdName=zhaohui6731, createdTime=Tue Jan 16 01:21:00 CST 2018, time=2018-01-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1392003, encodeId=6b7a1392003f8, content=<a href='/topic/show?id=3704891621c' target=_blank style='color:#2F92EE;'>#血流动力学#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89162, encryptionId=3704891621c, topicName=血流动力学)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=99cf2500102, createdName=zjshifan_98647306, createdTime=Tue Jan 16 01:21:00 CST 2018, time=2018-01-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1463188, encodeId=78b6146318898, content=<a href='/topic/show?id=cff92389310' target=_blank style='color:#2F92EE;'>#二尖瓣#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23893, encryptionId=cff92389310, topicName=二尖瓣)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=fdb26536308, createdName=wwzzly, createdTime=Tue Jan 16 01:21:00 CST 2018, time=2018-01-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1510118, encodeId=f24f1510118ac, content=<a href='/topic/show?id=e9bce8254ef' target=_blank style='color:#2F92EE;'>#经导管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78254, encryptionId=e9bce8254ef, topicName=经导管)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=93e010191378, createdName=lsj631, createdTime=Tue Jan 16 01:21:00 CST 2018, time=2018-01-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=278414, encodeId=296f2e8414a0, content=学习了.谢谢., beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/xkvRjYnJzzRJ2R0y7VhicibvkjPWHjIMmu4ZpKnE9cWAu4lVicS3uDUCfF4M4JWvrkrYfpb2KehPV0Ee29tPqyPEebBUibiaKhnvD/0, createdBy=f8412001184, createdName=惠映实验室, createdTime=Sun Jan 14 11:01:15 CST 2018, time=2018-01-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=278406, encodeId=f20c2e84064f, content=学习了.谢谢谢分享., beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=60791943465, createdName=1e0f8808m18(暂无匿称), createdTime=Sun Jan 14 10:55:04 CST 2018, time=2018-01-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=278398, encodeId=21342e83989d, content=学习了.涨知识, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220115/46bcf39c32de4aa6b45c5f9d66c8ee77/6cb4a20c55bb4b7691122f47747bfca2.jpg, createdBy=9dad1662329, createdName=1ddf0692m34(暂无匿称), createdTime=Sun Jan 14 10:43:24 CST 2018, time=2018-01-14, status=1, ipAttribution=)]
    2018-01-14 1e0f8808m18(暂无匿称)

    学习了.谢谢谢分享.

    0

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    2018-01-14 1ddf0692m34(暂无匿称)

    学习了.涨知识

    0

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使用FORTIS瓣膜的TMVR是可行的。TMVR后的MR降低在2年随访期间得到了维持,并且没有观察到晚期装置相关事件。

JACC:二尖瓣换瓣失败患者的TMVR治疗效果研究

目前,对于二尖瓣换瓣失败患者的经导管二尖瓣置换(TMVR)的数据尚缺乏。近日,在国际心血管权威杂志JACC上发表了一篇旨在评估二尖瓣生物膜失效(ViV)或瓣环成形术失败(ViR)患者的TMVR治疗效果的临床研究。本研究纳入分析了多个TMVR研究中心的数据库,共248例患者接受了TMVR治疗,经中隔途径和球囊自膨式瓣膜的使用率分别是33.1% 和89.9%。与176例ViV患者相比,72例ViR患者