JAMA Cardiol:左心室整体纵向应变与无症状性重度主动脉瓣狭窄的关联

2018-08-21 xiangting MedSci原创

以LV GLS受损为特征的亚临床性心肌功能障碍常见于保留LVEF的无症状性重度AS患者。

无症状性重度主动脉瓣狭窄(AS)患者的最佳手术时机仍存在争议。左心室整体纵向应变(LV GLS)有助于识别可能从早期主动脉瓣置换术中受益的患者。

这项研究旨在探讨在保留左室射血分数(LVEF)的无症状性重度AS患者中,LV GLS受损的患病率、LV GLS的自然病程及其预后意义。

这项基于注册的研究包括3个大型三级转诊中心的机构性注册,220例保留LVEF(>50%)的无症状性重度AS患者与220例年龄性别匹配的无结构性心脏病对照匹配。患者和对照的超声心动图在1998年至2017年间进行。

临床和超声心动图检查数据进行回顾性评估。重度AS定义为指数主动脉瓣面积小于0.6cm2/m2。使用斑点追踪成像在经胸超声心动图上评估左心室整体纵向应变。

主要结局和指标包括LV GLS受损患病率、LV GLS自然病程以及LV GLS受损与症状发作和主动脉瓣介入的关联。

共纳入了220例患者(平均[SD]年龄,68 [13]岁;126例男性[57%])。尽管LVEF相当,但与年龄性别匹配的无AS对照组相比,无症状性重度AS患者的LV GLS显著受损(平均[SD] LV GLS,-17.9%[2.5%] vs -19.6%[2.1%];P<0.001)。中位随访12个月后(四分位间距,7-23),平均(SD)LV GLS显著恶化(-18.0%[2.6%]至-16.3%[2.8%]; P<0.001),而LVEF保持不变。与LV GLS保留较多的患者相比,基线LV GLS受损患者(> -18.2%)随访时出现症状(P=0.02)和需要主动脉瓣介入治疗的风险较高(P=0.03)。

以LV GLS受损为特征的亚临床性心肌功能障碍常见于保留LVEF的无症状性重度AS患者。左心室整体纵向应变随时间进一步恶化,并且基线时LV GLS受损与进展为症状性阶段和需要主动脉瓣介入治疗的风险升高相关。

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  6. [GetPortalCommentsPageByObjectIdResponse(id=1774583, encodeId=8d8e1e74583cd, content=<a href='/topic/show?id=a64f95e9906' target=_blank style='color:#2F92EE;'>#重度主动脉瓣狭窄#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=95799, encryptionId=a64f95e9906, topicName=重度主动脉瓣狭窄)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=773e38606601, createdName=lxg964, createdTime=Fri Jan 04 23:54:00 CST 2019, time=2019-01-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1781940, encodeId=93eb1e819403f, content=<a href='/topic/show?id=5db8409ed8' target=_blank style='color:#2F92EE;'>#Cardiol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=19, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4097, encryptionId=5db8409ed8, topicName=Cardiol)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8e886, createdName=仁者大医, createdTime=Wed Apr 24 10:54:00 CST 2019, time=2019-04-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1332550, encodeId=fb3113325507d, content=<a href='/topic/show?id=1dd6231822d' target=_blank style='color:#2F92EE;'>#主动脉瓣#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23182, encryptionId=1dd6231822d, topicName=主动脉瓣)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=dc4b2500077, createdName=hittouch, createdTime=Thu Aug 23 07:54:00 CST 2018, time=2018-08-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1413236, encodeId=30ed141323616, content=<a href='/topic/show?id=1d7e48033f5' target=_blank style='color:#2F92EE;'>#左心室#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=48033, encryptionId=1d7e48033f5, topicName=左心室)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=15012955474, createdName=wushaoling, createdTime=Thu Aug 23 07:54:00 CST 2018, time=2018-08-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1415364, encodeId=369014153641e, content=<a href='/topic/show?id=04812314540' target=_blank style='color:#2F92EE;'>#主动脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23145, encryptionId=04812314540, topicName=主动脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=77603112682, createdName=circumcision, createdTime=Thu Aug 23 07:54:00 CST 2018, time=2018-08-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1485013, encodeId=045d14850130c, content=<a href='/topic/show?id=4bbe5902ed2' target=_blank style='color:#2F92EE;'>#无症状#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=19, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=59027, encryptionId=4bbe5902ed2, topicName=无症状)], attachment=null, authenticateStatus=null, createdAvatar=Bioon/avatar/20180429/70baad2aa5a046c5aa2914d262de7d37.jpg, createdBy=bd077990475, createdName=12498da4m34(暂无昵称), createdTime=Thu Aug 23 07:54:00 CST 2018, time=2018-08-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=339963, encodeId=12763399635b, content=好, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0aa31415219, createdName=orangesking, createdTime=Tue Aug 21 17:15:02 CST 2018, time=2018-08-21, status=1, ipAttribution=)]
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    2018-08-21 orangesking

    0