NEJM:心肌活力与缺血性心肌病远期预后的关系

2019-08-22 MedSci MedSci原创

研究认为,冠状动脉旁路移植术对心肌活力与缺血性心肌病患者的长期预后无关,心肌活力与左室收缩功能改善有关,而与治疗无关,但这种改善与长期存活无关

心肌活力评估在缺血性心肌病患者外科血管重建中作用仍然存在争议。虽然改善左室功能是血管重建的目标之一,但其与后续结果的关系尚不清楚。

近日研究人员招募601例计划接受冠状动脉旁路移植术(CABG)且左室射血分数为35%或更低的患者,前瞻性地使用单光子发射计算机断层显像、多巴酚丁胺超声心动图或两者同时评估患者心肌存活能力。患者被随机分配接受CABG并接受药物治疗或单独接受药物治疗。在基线和随访4个月后对318例患者进行左室射血分数测定。研究的主要的终点是任何原因的死亡,随访10.4年。

研究发现,GABG联合药物治疗后,患者全因死亡风险降低(182/298 vs209/303.HR=0.73),然而没有观察到GABG联合药物治疗后对心肌活力显著影响。左室射血分数增加与心肌活力相关,而与治疗方法无关,左心室射血分数变化与后续死亡无相关性。

研究认为,冠状动脉旁路移植术对心肌活力与缺血性心肌病患者的长期预后无关,心肌活力与左室收缩功能改善有关,而与治疗无关,但这种改善与长期存活无关。

原始出处:

Julio A. Panza et al. Myocardial Viability and Long-Term Outcomes in Ischemic Cardiomyopathy. N Engl J Med, August 22, 2019.

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  5. [GetPortalCommentsPageByObjectIdResponse(id=1984385, encodeId=4e101984385b5, content=<a href='/topic/show?id=c4bb9443038' target=_blank style='color:#2F92EE;'>#远期预后#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=94430, encryptionId=c4bb9443038, topicName=远期预后)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1c2e485, createdName=yangfl06, createdTime=Thu Jan 23 10:03:00 CST 2020, time=2020-01-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1893205, encodeId=0d4f18932055e, content=<a href='/topic/show?id=c738e93521f' target=_blank style='color:#2F92EE;'>#缺血性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79352, encryptionId=c738e93521f, topicName=缺血性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=66ec123, createdName=guihongzh, createdTime=Wed Nov 13 05:03:00 CST 2019, time=2019-11-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1523426, encodeId=2005152342660, content=<a href='/topic/show?id=2553e9365a9' target=_blank style='color:#2F92EE;'>#缺血性心肌病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79365, encryptionId=2553e9365a9, topicName=缺血性心肌病)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=11ec11518906, createdName=huanbaofeng, createdTime=Sat Aug 24 10:03:00 CST 2019, time=2019-08-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1622404, encodeId=fa911622404ce, content=<a href='/topic/show?id=b9578094833' target=_blank style='color:#2F92EE;'>#肌病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=80948, encryptionId=b9578094833, topicName=肌病)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=395f25, createdName=爆笑小医, createdTime=Sat Aug 24 10:03:00 CST 2019, time=2019-08-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=371680, encodeId=8a353e168086, content=学习学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=85, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRkia1DP5MpwEgtXo1XhXA11xD6MWKxunAZFXKSNic0fWHUQx83oNHPlRMxxIctM83QKeCLkJpMibibiaC/0, createdBy=7e581734408, createdName=深海的鱼, createdTime=Fri Aug 23 05:42:25 CST 2019, time=2019-08-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=371674, encodeId=90493e167429, content=学习了,学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzTetibytbqFDmFITWHyBWbxU7S9MYibgPSqvu0sYteH0N6zXqbU0Kf3Mbdb7yWM1Kud3zPgYBibE2SZ/0, createdBy=da7696924, createdName=qingfengqishi5, createdTime=Thu Aug 22 23:00:55 CST 2019, time=2019-08-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1034929, encodeId=9cd61034929b7, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Thu Aug 22 22:03:00 CST 2019, time=2019-08-22, status=1, ipAttribution=)]
    2019-08-23 深海的鱼

    学习学习学习

    0

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    2019-08-22 qingfengqishi5

    学习了,学习了

    0

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    2019-08-22 旺医

    顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息

    0

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