JACC:低流量、低梯度和高梯度主动脉瓣狭窄患者TAVR后的1年生存率

2019-04-20 xiangting MedSci原创

这是首个在匹配研究人群中比较高MPG与低MPG患者TAVR后生存率的研究。LFLG-AS患者的死亡率是HG-AS患者的2倍。

这项研究旨在探讨即使在严格匹配基线参数后,跨瓣平均压力梯度(MPGs)高vs低的严重主动脉瓣狭窄患者(AS)经导管主动脉瓣置换术(TAVR)后的预后是否存在本质的差异。

低MPG患者的特征是与其他AS患者相比,具有更高的血管风险和更多的合并症。

在这项回顾性、单中心研究中,纳入2,282名患者,根据以下标准分成3组:1)高梯度AS(HG-AS)(MPG≥40mmHg); 2)低流量、低梯度AS(LFLG-AS)(MPG<40mmHg,射血分数[EF]≤40%,每搏输出量指数≤35ml/m2);3)异常LFLG-AS(pLFLG-AS)(类似于LFLG-AS,但EF≥50%)。使用包括EF在内的倾向得分匹配比较1年生存率。

共确定了136例HG-AS或LFLG-AS患者。Kaplan-Meier生存曲线明显不同(p=0.039),分别有11例vs 21例患者死亡(风险比:2.12; 95%置信区间:1.02-4.39;p=0.044)。共确定了226例HG-AS或pLFLG-AS患者,此处曲线相同(p=0.468),分别有18例vs 21例患者死亡(风险比:1.26; 95%置信区间:0.67-2.38;p=0.469)。

这是首个在匹配研究人群中比较高MPG与低MPG患者TAVR后生存率的研究。LFLG-AS患者的死亡率是HG-AS患者的2倍。然而,pLFLG-AS患者从TAVR获益的程度似乎与HG-AS患者相同。肯定还存在影响LFLG-AS患者死亡率的明显因素。

原始出处:

Ulrich Fischer-Rasokat. 1-Year Survival After TAVR of Patients With Low-Flow, Low-Gradient and High-Gradient Aortic Valve Stenosis in Matched Study Populations. JACC:Cardiovascular Interventions. 22 April 2019.

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    2019-05-24 hbwxf
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