O'Driscoll Jamie M, Bahia Sandeep S, Gravina Angela, Di Fino Sara, Thompson Matthew M, Karthikesalingam Alan, Holt Peter J E, Sharma Rajan
From the Department of Cardiology, St George's Healthcare NHS Trust, London, United Kingdom (J.M.O., A.G., S.D.F., R.S.); School of Human and Life Sciences, Canterbury Christ Church University, Kent, United Kingdom (J.M.O.); and Department of Outcomes Research, St George's Vascular Institute, St George's University of London, Cranmer Terrace, London, United Kingdom (S.S.B., M.M.T., A.K., P.J.E.H.).
Circ Cardiovasc Imaging. 2016 Feb;9(2):e003557. doi: 10.1161/CIRCIMAGING.115.003557.
The value of performing transthoracic echocardiography (TTE) as part of the clinical assessment of patients awaiting endovascular repair of the abdominal aorta is little evaluated. We aimed to estimate the prognostic importance of information derived from TTE on long-term all-cause mortality in a selected group of patients undergoing endovascular aneurysm repair.
This was a retrospective cohort study of 273 consecutive patients selected for endovascular aneurysm repair. All patients included in the analysis underwent TTE before their procedure. Multivariable Cox regression analysis was used to estimate the effect of TTE measures on all-cause mortality. Over a mean follow-up of 3.2±1.5 years, there were 78 deaths with a mean time to death of 1.28±1.16 years. A greater tubular ascending aorta (hazard ratio [HR] 5.6, 95% confidence interval [CI] 2.77-11.33), presence of mitral regurgitation (HR 8.13, 95% CI 4.09-12.16), lower left ventricular ejection fraction (HR 0.96, 95% CI 0.93-0.98), younger age (HR 0.97, 95% CI 0.95-0.99), and presence of diabetes mellitus (HR 1.46, 95% CI 1.24-1.89) were predictors of all-cause mortality.
Echocardiography provides important long-term prognostic information in patients undergoing endovascular aneurysm repair. These TTE indices were more important at predicting outcome than standard conventional risk factors in this patient group. A greater tubular ascending aorta, presence of mitral regurgitation, reduced left ventricular ejection fraction, younger age, and diabetes mellitus were independently associated with long-term mortality.
作为等待腹主动脉腔内修复患者临床评估一部分的经胸超声心动图（TTE）的价值评估较少。我们旨在评估TTE所获信息对一组接受腔内动脉瘤修复患者长期全因死亡率的预后重要性。
这是一项对273例连续入选腔内动脉瘤修复患者的回顾性队列研究。所有纳入分析的患者在手术前均接受了TTE检查。采用多变量Cox回归分析来评估TTE指标对全因死亡率的影响。在平均3.2±1.5年的随访期内，有78例死亡，平均死亡时间为1.28±1.16年。升主动脉管径增大（风险比[HR] 5.6，95%置信区间[CI] 2.77 - 11.33）、存在二尖瓣反流（HR 8.13，95% CI 4.09 - 12.16）、左心室射血分数降低（HR 0.96，95% CI 0.93 - 0.98）、年龄较轻（HR 0.97，95% CI 0.95 - 0.99）以及存在糖尿病（HR 1.46，95% CI 1.24 - 1.89）是全因死亡率的预测因素。
超声心动图为接受腔内动脉瘤修复的患者提供了重要的长期预后信息。在该患者群体中，这些TTE指标在预测结局方面比标准传统风险因素更为重要。升主动脉管径增大、存在二尖瓣反流、左心室射血分数降低、年龄较轻以及糖尿病与长期死亡率独立相关。
