Eur Heart J:TAVI患者中主动脉瓣狭窄和心脏淀粉样变性的患病率和预后

2020-04-09 xiangting MedSci原创

AS-淀粉样蛋白比较常见,并且不同于单独的AS。经导管主动脉瓣植入术可显著改善AS-淀粉样蛋白的预后,而围手术期并发症和死亡率与单独的AS相似。

心脏淀粉样变性在经导管主动脉瓣植入(TAVI)的老年主动脉瓣狭窄(AS)患者中很常见。这项研究假设同时患主动脉瓣狭窄和心脏淀粉样变性(AS-淀粉样蛋白)的患者具有不同的基线特征、围手术期和死亡率结局。

年龄≥75岁的重度AS患者TAVI术前在两个地方接受进行盲法骨闪烁显像(0级阴性,1-3级阳性逐渐增加)。基线评估包括超声心动图、心电图(ECG)、血液测试、6分钟步行测试和健康问卷,并进行围手术期并发症和死亡率随访。

招募了200例患者(年龄85±5岁,男性占50%)。在26例患者(13%)中发现了AS-淀粉样蛋白:1级8例、2级18例。AS-淀粉样蛋白患者的年龄较大(88±5 vs. 85±5岁,P=0.001),生活质量降低(EQ-5D-5L 50 vs.65,P=0.04),左心室壁厚度较高(14mm vs.13mm,P=0.02),ECG电压较低(Sokolow–Lyon 1.9±0.7 vs.2.5±0.9mV,P=0.03),并且电压/质量比较低(0.017 vs.0.025 mV/g/m2,P=0.03)。高敏肌钙蛋白T和N端前脑利钠肽更高(41 vs.21ng/L,P<0.001;3702 vs.1254ng/L,P=0.001)。性别、合并症、6分钟步行距离、AS严重度、不成比例肥大的患病率以及TAVI术后并发症发生率(38%vs. 35%,P=0.82)相同。中位随访19个月时(10-27),死亡率无差异(P=0.71)。经导管主动脉瓣植入术明显改善了总人群(P<0.001)和AS-淀粉样蛋白患者(P=0.03)的预后。

AS-淀粉样蛋白比较常见,并且不同于单独的AS。经导管主动脉瓣植入术可显著改善AS-淀粉样蛋白的预后,而围手术期并发症和死亡率与单独的AS相似,这表明AS-淀粉样蛋白患者不应拒绝TAVI。

原始出处:

Paul R Scully. Prevalence and outcome of dual aortic stenosis and cardiac amyloid pathology in patients referred for transcatheter aortic valve implantation. Eur Heart J. 08 April 2020.

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    2020-04-11 zhaojie88
  5. 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  7. 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  8. 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    2020-04-11 huangdf
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