主动脉瓣狭窄患者的性别、年龄和预先存在的脑缺血性疾病。
Sex, aging, and preexisting cerebral ischemic disease in patients with aortic stenosis.
机构信息
Department of Radiology, The University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA.
出版信息
Ann Thorac Surg. 2010 Oct;90(4):1230-5. doi: 10.1016/j.athoracsur.2010.04.016.
BACKGROUND
Patients undergoing cardiac surgery have a high frequency of preexisting cerebral ischemic lesions, the presence of which appears to predict cognitive sequelae. Patients undergoing aortic valve replacement for aortic stenosis (AS) incur an exceptionally high risk for perioperative cerebral ischemia. The extreme risk in this subgroup may arise from the preexisting burden of cerebral ischemic disease. We tested the hypotheses that increasing age, female sex, coronary artery disease, and the severity of AS are predictive of the severity of preexisting cerebral ischemic lesions.
METHODS
A total of 95 subjects were included in this study. Subjects were imaged on 1.5 Tesla magnetic resonance imaging scanners to obtain multimodal image sets which were used for the automatic segmentation of cerebral lesion volume. The dependence of lesion volume upon age, sex, coronary artery disease, and the severity of AS were tested.
RESULTS
The results demonstrate a strong correlation between aging, female sex, and white matter and ischemia-like lesion volume in patients with aortic stenosis.
CONCLUSIONS
Women and those of advanced age presenting for aortic valve replacement for AS may incur a particularly high risk for postoperative neurologic sequelae due to an exceptional preexisting burden of cerebral ischemic disease.
背景
接受心脏手术的患者存在较高频率的预先存在的脑缺血性病变，其存在似乎可预测认知后遗症。主动脉瓣狭窄（AS）患者行主动脉瓣置换术会发生围手术期脑缺血的极高风险。该亚组的极高风险可能源于预先存在的脑缺血性疾病负担。我们检验了以下假设：年龄增长、女性、冠状动脉疾病和 AS 的严重程度可预测预先存在的脑缺血性病变的严重程度。
方法
本研究共纳入 95 例患者。对患者进行 1.5T 磁共振成像扫描仪成像，以获得多模态图像集，用于自动分割脑病变体积。对病变体积与年龄、性别、冠状动脉疾病和 AS 严重程度的依赖性进行了测试。
结果
结果表明，在患有主动脉瓣狭窄的患者中，衰老、女性和白质与缺血样病变体积之间存在很强的相关性。
结论
由于预先存在的脑缺血性疾病负担异常高，女性和因 AS 接受主动脉瓣置换术的高龄患者可能会发生特别高的术后神经后遗症风险。
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