Circ-Heart Fail:左心室辅助装置应用中的性别差异

2019-09-17 国际循环编辑部 国际循环

女性约占晚期心力衰竭人群的三分之一,但接受治疗的仅占少数,包括左心室辅助装置(LVADs)。在早期脉动流装置期,女性植入LVAD后死亡率更高,并发症增加。然而,关于连续流装置期差异的认识有限。因此,Aditya A. Joshi等研究者试图探讨按性别划分的LVAD使用率和LVAD后死亡率的时间趋势。

女性约占晚期心力衰竭人群的三分之一,但接受治疗的仅占少数,包括左心室辅助装置(LVADs)。在早期脉动流装置期,女性植入LVAD后死亡率更高,并发症增加。然而,关于连续流装置期差异的认识有限。因此,Aditya A. Joshi等研究者试图探讨按性别划分的LVAD使用率和LVAD后死亡率的时间趋势。
 
研究纳入2004年~2016年植入LVAD的住院患者,按性别和辅助装置时间比较LVAD使用率和LVAD后住院病死率的变化趋势。虽然,LVAD越来越多地用于晚期收缩性心力衰竭患者,但女性植入LVAD的比例较小,2004年为25.8%,2016年为21.9%(趋势P=0.91)。LVAD植入后患者的住院病死率高于脉动流期男性(46.9% vs. 31.1%,P<0.0001),但在连续流期则非如此(13.3% vs. 12.1%,P=0.27;相互作用P=0.0002)。植入LVAD后不同性别患者的住院病死率随时间的推移而下降,2008年~2009年急剧下降。女性与植入LVAD后住院病死率增加独立相关,超过校正的脉动流期人口统计学和风险因素(OR=2.13;95%CI:1.45~3.10;P<0.0001)但在连续流期则非如此(OR=1.18;95%CI:0.93~1.48; P=0.16)。
 
尽管LVAD疗法的使用随时间的推移而增加,但女性植入LVAD仍处于稳定低水平,提示这种挽救生命的疗法未被充分利用,还需开展前瞻性研究以进一步证实此发现。
 
原始出处:
Aditya A. Joshi, Joseph B. Lerman, Aparna P. Sajja, et al. Sex-Based Differences in Left Ventricular Assist Device Utilization. Circulation: Heart Failure. Sep 2019

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    2019-09-19 zhaojie88
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    2019-09-19 slcumt

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