盘点:主动脉狭窄近期重要研究进展汇总

2018-09-30 MedSci MedSci原创

22

【1】多巴酚丁胺负荷的超声心动图对低流量、低压差主动脉瓣狭窄的管理价值

美国ACC/AHA指南推荐,若多巴酚丁胺负荷的超声心动图检查(DSE)显示主动脉瓣面积(AVA)≤1 cm2、平均跨瓣压(MG)≥40 mm Hg则视为存在真性重度狭窄。但既往尚无研究对上述标准进行验证。JACC发表的一项最新研究探讨对于低流量、低压差主动脉瓣狭窄(LF-LG AS)患者,上述标准对于真性重度主动脉瓣狭窄(AS)及死亡的预测价值。该前瞻性研究共计入选186例左心室射血分数较低的LF-LG AS患者,行DSE测定MG、AVA,并根据标准正常流速估计AVA的预计值(AVAProj)。结果表明,对于左心室射血分数较低的LF-LG AS患者,ACC/AHA指南提出的用于识别真性严重AS标准即DSE峰值负荷时MG≥40 mm Hg、MG≥40 mm Hg+AVA≤1 cm2对于真实狭窄严重程度及结局的预测价值有限。相反,AVAProj能更好地实现对假性严重AS和真性严重AS的鉴别,且与保守治疗患者的死亡率有较强的相关性。

【2】左心室不对称性对无症状性主动脉瓣狭窄患者的预后意义

主动脉瓣狭窄患者左心室(LV)不对称较为常见,以LV局部肥厚的形式表现出来。近日,一项新的研究旨在检验LV不对称性可以预测无症状主动脉瓣狭窄患者未来症状状态和主动脉瓣置换术(AVR)指征这一假设。该研究共纳入了114名无症状性主动脉瓣狭窄患者。随访中位时间为2.2年。出现AVR指征的患者有46例(40%)。LV不对称患者进行AVR的风险是无LV不对称的患者的3倍。多变量Cox分析显示LV不对称是未来需要进行AVR的一个预测因子,并且独立于LV几何形状、射流速度、瓣膜钙化和pro-BNP。由此可见,LV不对称性是未来无症状主动脉瓣狭窄患者需要进行AVR的独立预测因子。它对LV几何形态具有增量预测价值,并可能提供有用方法进行危险分层。

【3】LVEF降低的主动脉瓣狭窄患者预后更差

对于部分严重的主动脉瓣狭窄(AS)患者,其左室射血分数(LVEF)有所降低。一项新的研究评估了LVEF降低对严重AS患者预后的影响以及预测其的因素。研究纳入了938例诊断为严重AS的患者,并对所有患者进行了一系列的心超检查,在随访的10年期间,共获得3684个(平均3个/患者)心超图像。分析结果发现,在最初的诊断中,有196例(21%)患者的LVEF<50% (35.1 ± 9.7%),对于这些诊断为AS之前LVEF就已经<50%的患者,其LVEF恶化速度更快,而最初LVEF≥50%的患者随访后的平均LVEF>60%,预测LVEF恶化的关联性最强的因子是诊断AS前3年患者的LVEF<60%。在平均3.3年的随访时间里,与LVEF≥60%的患者相比,LVEF<60%患者的死亡率明显更高。表明在严重主动脉瓣狭窄患者中,诊断AS前LVEF就有所下降的患者预后更差,LVEF<60%患者的死亡率要更高。

【4】重度主动脉瓣狭窄患者的猝死

据报道,无症状性重度主动脉瓣狭窄(AS)患者猝死的年发病率较低(<1%/年),并且关于重度AS患者猝死危险因素的数据很少。当代重度主动脉瓣狭窄患者手术和内科治疗后的预后登记(CURRENT AS),于2003年至2011年间共纳入3815例连续性重度AS患者,研究人员评估了1334天的中位随访期内的猝死发病率和危险因素。患者平均年龄为78岁,男性占38%,既往心梗的患病率为8%。175例未接受主动脉瓣置换的患者猝死。作为竞争风险的主动脉瓣置换时的有症状患者猝死5年累积发生率为9.2%,无症状患者为7.2%。在猝死的82例无症状患者中,54例(66%)突然死亡,没有任何先兆,35例(65%)在最后一次随访的3个月内猝死。猝死的独立危险因素为血液透析,既往心梗,BMI<22,主动脉搏动峰值速度≥5m/s和左室射血分数<60%。无症状性重度AS患者的猝死发生率可能高于先前报道。几项基线临床和超声心动图特征与猝死风险升高相关。

【5】严重主动脉瓣狭窄患者的心肌瘢痕与死亡率

主动脉瓣狭窄(AS)患者进行主动脉瓣置换术(AVR)主要取决于症状的发展; 但是晚期手术可能导致不可逆的心肌功能障碍和额外的风险。近日,心血管领域权威杂志Circulation上发表了一篇研究文章,该研究旨在确定术前存在局灶性心肌瘢痕是否与长期死亡率相关。在纵向观察结果研究中,研究人员对在英国6个心胸中心进行瓣膜介入治疗的严重AS患者进行生存分析。674例重度AS患者,瘢痕占51%(18%为梗死型; 33%为非梗塞型。治疗方法包括手术或经导管治疗。在随访期间,145例(21.5%)死亡。在多变量分析中,与全因死亡率独立相关的因素包括年龄、STS评分和瘢痕。无论干预如何,瘢痕均独立预测全因和心血管死亡率。LV心肌瘢痕负荷每增加1%,全因死亡率上升11%,心血管死亡率上升8%。由此可见,在严重AS患者中,晚期钆增加心血管MR与死亡率独立相关; 心肌瘢痕的存在与晚期死亡率增加2倍有关。

版权声明:
本网站所有内容来源注明为“梅斯医学”或“MedSci原创”的文字、图片和音视频资料,版权均属于梅斯医学所有。非经授权,任何媒体、网站或个人不得转载,授权转载时须注明来源为“梅斯医学”。其它来源的文章系转载文章,或“梅斯号”自媒体发布的文章,仅系出于传递更多信息之目的,本站仅负责审核内容合规,其内容不代表本站立场,本站不负责内容的准确性和版权。如果存在侵权、或不希望被转载的媒体或个人可与我们联系,我们将立即进行删除处理。
在此留言
评论区 (4)
#插入话题
  1. [GetPortalCommentsPageByObjectIdResponse(id=1315158, encodeId=c4db131515891, content=<a href='/topic/show?id=c115231e9dc' target=_blank style='color:#2F92EE;'>#主动脉狭窄#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23179, encryptionId=c115231e9dc, topicName=主动脉狭窄)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2f8f432, createdName=longerg, createdTime=Tue Oct 02 14:57:00 CST 2018, time=2018-10-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1381093, encodeId=857f1381093aa, content=<a href='/topic/show?id=9281e34519b' target=_blank style='color:#2F92EE;'>#研究进展#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=17, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=73451, encryptionId=9281e34519b, topicName=研究进展)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=hb2008ye, createdTime=Tue Oct 02 14:57:00 CST 2018, time=2018-10-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1415380, encodeId=9e43141538015, 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=34, 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=Tue Oct 02 14:57:00 CST 2018, time=2018-10-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1496905, encodeId=1d1c149690539, content=<a href='/topic/show?id=217b33259df' target=_blank style='color:#2F92EE;'>#动脉狭窄#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=33259, encryptionId=217b33259df, topicName=动脉狭窄)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b4ae9287436, createdName=piaojinhua, createdTime=Tue Oct 02 14:57:00 CST 2018, time=2018-10-02, status=1, ipAttribution=)]
  2. [GetPortalCommentsPageByObjectIdResponse(id=1315158, encodeId=c4db131515891, content=<a href='/topic/show?id=c115231e9dc' target=_blank style='color:#2F92EE;'>#主动脉狭窄#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23179, encryptionId=c115231e9dc, topicName=主动脉狭窄)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2f8f432, createdName=longerg, createdTime=Tue Oct 02 14:57:00 CST 2018, time=2018-10-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1381093, encodeId=857f1381093aa, content=<a href='/topic/show?id=9281e34519b' target=_blank style='color:#2F92EE;'>#研究进展#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=17, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=73451, encryptionId=9281e34519b, topicName=研究进展)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=hb2008ye, createdTime=Tue Oct 02 14:57:00 CST 2018, time=2018-10-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1415380, encodeId=9e43141538015, 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=34, 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=Tue Oct 02 14:57:00 CST 2018, time=2018-10-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1496905, encodeId=1d1c149690539, content=<a href='/topic/show?id=217b33259df' target=_blank style='color:#2F92EE;'>#动脉狭窄#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=33259, encryptionId=217b33259df, topicName=动脉狭窄)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b4ae9287436, createdName=piaojinhua, createdTime=Tue Oct 02 14:57:00 CST 2018, time=2018-10-02, status=1, ipAttribution=)]
  3. [GetPortalCommentsPageByObjectIdResponse(id=1315158, encodeId=c4db131515891, content=<a href='/topic/show?id=c115231e9dc' target=_blank style='color:#2F92EE;'>#主动脉狭窄#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23179, encryptionId=c115231e9dc, topicName=主动脉狭窄)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2f8f432, createdName=longerg, createdTime=Tue Oct 02 14:57:00 CST 2018, time=2018-10-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1381093, encodeId=857f1381093aa, content=<a href='/topic/show?id=9281e34519b' target=_blank style='color:#2F92EE;'>#研究进展#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=17, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=73451, encryptionId=9281e34519b, topicName=研究进展)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=hb2008ye, createdTime=Tue Oct 02 14:57:00 CST 2018, time=2018-10-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1415380, encodeId=9e43141538015, 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=34, 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=Tue Oct 02 14:57:00 CST 2018, time=2018-10-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1496905, encodeId=1d1c149690539, content=<a href='/topic/show?id=217b33259df' target=_blank style='color:#2F92EE;'>#动脉狭窄#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=33259, encryptionId=217b33259df, topicName=动脉狭窄)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b4ae9287436, createdName=piaojinhua, createdTime=Tue Oct 02 14:57:00 CST 2018, time=2018-10-02, status=1, ipAttribution=)]
  4. [GetPortalCommentsPageByObjectIdResponse(id=1315158, encodeId=c4db131515891, content=<a href='/topic/show?id=c115231e9dc' target=_blank style='color:#2F92EE;'>#主动脉狭窄#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23179, encryptionId=c115231e9dc, topicName=主动脉狭窄)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2f8f432, createdName=longerg, createdTime=Tue Oct 02 14:57:00 CST 2018, time=2018-10-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1381093, encodeId=857f1381093aa, content=<a href='/topic/show?id=9281e34519b' target=_blank style='color:#2F92EE;'>#研究进展#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=17, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=73451, encryptionId=9281e34519b, topicName=研究进展)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=hb2008ye, createdTime=Tue Oct 02 14:57:00 CST 2018, time=2018-10-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1415380, encodeId=9e43141538015, 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=34, 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=Tue Oct 02 14:57:00 CST 2018, time=2018-10-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1496905, encodeId=1d1c149690539, content=<a href='/topic/show?id=217b33259df' target=_blank style='color:#2F92EE;'>#动脉狭窄#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=33259, encryptionId=217b33259df, topicName=动脉狭窄)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b4ae9287436, createdName=piaojinhua, createdTime=Tue Oct 02 14:57:00 CST 2018, time=2018-10-02, status=1, ipAttribution=)]