Eur Heart J:性别对主动脉瓣狭窄患者治疗和结局的影响

2021-05-24 MedSci原创 MedSci原创

尽管AS严重程度和基线血流动力学相似,但女性很少接受瓣膜介入治疗(AVR),且死亡率更高。这似乎主要发生在AS严重程度不一致的患者亚群中(即低梯度AS),而女性较少接受AVR。

主动脉瓣狭窄(AS)的治疗和结局是否存在性别差异,尚未明确。近日,血管领域权威杂志Eur Heart J上发表了一篇研究文章,这项研究旨在根据AS的严重程度评估性别对AS患者治疗和结局的影响。

研究人员在2005年至2015年期间前瞻性地收集了至少轻至中度[主动脉瓣面积(AVA)≤1.5cm2和峰值射流速度(VPeak)≥2.5m/s或平均梯度(MG)≥25mmHg]AS患者的多普勒超声心动图数据,并进行回顾性分析。研究人员排除了左室射血分数降低(<50%)或轻度以上二尖瓣或主动脉瓣反流的患者。

在3632名患者中,女性占42%。男性和女性患者平均AVA(0.48±0.17 cm2/m2)、VPeak(3.74±0.88 m/s)和MG(35.1±18.2 mmHg)没有差异(所有P≥0.18)。与男性相比,女性患者年龄更大(72.9±13.0 vs. 70.1±11.8岁),高血压程度更高(75% vs. 70%;P=0.0005),冠心病更少(38% vs. 55%,P<0.0001)。

总体生存率

在逆向加权(IPW)之后,女性的死亡率较高(IPW-HR:1.91 [1.14-3.22];P=0.01),而接受瓣膜介入治疗的比例较低(竞争性模型IPW-HR:0.88[0.82-0.96] ];P=0.007)。在最初采用保守治疗的非严重AS患者中(IPW-HR=1.03 [0.63-1.68];P=0.88)或通过瓣膜介入治疗的AS患者中(IPW-HR=1.25 [0.71-2.21];P=0.43)过高的死亡率有所降低。有趣的是,在女性低梯度AS患者中观察到了过高的死亡率(IPW-HR=2.17 [1.19–3.95];P=0.01),而女性患者较少接受瓣膜介入治疗(IPW-Sub-HR:0.83 [0.73] –0.95]; P = 0.009)。

由此可见,尽管AS严重程度和基线血流动力学相似,但女性很少接受瓣膜介入治疗(AVR),且死亡率更高。这似乎主要发生在AS严重程度不一致的患者亚群中(即低梯度AS),而女性较少接受AVR

原始出处:

David Bienjonetti-Boudreau.et al.Impact of sex on the management and outcome of aortic stenosis patients.European Heart Journal.2021.https://doi.org/10.1093/eurheartj/ehab242

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    2021-05-26 zhaojie88
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    2021-05-26 slcumt
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    2021-05-24 tanxingdoctor

    学习了,谢谢分享啦

    0

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