JAHA:动脉特性作为严重主动脉瓣狭窄左心室质量和纤维化的决定因素

2018-12-30 xiangting MedSci原创

与动物研究一致,动脉波反射与严重主动脉瓣狭窄患者的间隙容量扩大相关,并可以预测AVR后较小的生活质量改善。

人们越来越多地认识到动脉负荷在严重主动脉瓣狭窄中的作用。然而,搏动负荷的类型及其在该人群中的意义仍然未知。这项研究目的是评估动脉特性与以下两点的关联:(1)左心室重塑和纤维化;(2)接受主动脉瓣置换(AVR)的严重主动脉瓣狭窄患者的临床病程。

研究招募了38名计划接受外科AVR的症状性严重主动脉瓣狭窄患者。用心脏磁共振成像测量主动脉根部特征阻抗、波反射参数(反射幅度、反射波传播时间)和心肌细胞外质量。30名参与者在6个月时重复进行动脉张力心脏磁共振成像。AVR后细胞质量减少(133.6 vs 113.9g; P=0.002),但细胞外质量不减少(42.3 vs 40.6g; P=0.67)。细胞外质量较高的参与者反射幅度较大(0.68 vs 0.54; P=0.006)、主动脉根部特征阻抗较低(56.3 vs 96.9 dynes/s每cm5;P=0.006)。反射幅度是AVR后生活质量改善较小的一个重要预测因素(堪萨斯城心肌病问卷评分)(R=-0.51;P=0.0026)。AVR后6个月的6分钟步行距离与反射波传播时间呈正相关(R=0.52;P=0.01)。

与动物研究一致,动脉波反射与严重主动脉瓣狭窄患者的间隙容量扩大相关,并可以预测AVR后较小的生活质量改善。未来的试验应该评估波反射是否可以代表减轻心肌间质重塑和改善该患者人群临床状态的潜在治疗靶点。

原始出处:

Julio A. Chirinos. Arterial Properties as Determinants of Left Ventricular Mass and Fibrosis in Severe Aortic Stenosis: Findings From ACRIN PA 4008. JAHA. 28 December 2018.

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    2019-01-01 zhaohui6731
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