中国成年人动脉导管未闭经皮封堵术后左心室大小及功能

Left ventricular size and function after percutaneous closure of patent ductus arteriosus in Chinese adults.

作者信息

Zhan Zhi, Guan Lihua, Pan Wenzhi, Zhang Xiaochun, Zhang Lei, Zhou Daxin, Ge Junbo

机构信息

Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China.

出版信息

Int J Cardiol. 2020 Sep 15;315:24-28. doi: 10.1016/j.ijcard.2020.04.060. Epub 2020 Apr 22.

DOI:10.1016/j.ijcard.2020.04.060

PMID:32333933

Abstract

BACKGROUND

Left ventricular (LV) systolic dysfunction can occur after patent ductus arteriosus (PDA) closure and data in adult Chinese patients are lacking.

METHODS

We examined adult Chinese patients who underwent successful transcatheter PDA closure at Zhongshan Hospital. Echocardiographic studies were performed before closure, before discharge, and at 1, 3, 6, and 12 months after closure. A total of 430 patients were included between January 2010 and December 2016. Patients were divided into two groups based on LV end-diastolic diameter (LVEDD): Dilated LV Group: >56 mm (n = 191) and Non-dilated LV Group: ≤56 mm (n = 239).

RESULTS

LVEDD and LV ejection fraction (LVEF) were significantly decreased immediately after closure. Reductions in LVEDD (-10.5% ± 7.1% vs. -4.6% ± 7.0%, P < 0.001) and LVEF (-8.9% ± 12.6% vs. -2.1% ± 8.6%, P < 0.001) were greater in the Dilated LV Group. LV end-systolic diameter (LVESD) remained unchanged compared to levels before closure (-4.0% ± 5.4%, P = 0.257; -2.6% ± 5.4%, P = 0.201). 48 patients in the Dilated LV Group (25.1%) and 7 patients in the Non-dilated LV Group (2.9%) developed late LV systolic dysfunction. In multivariable analysis, LVEF ≥60%, LVEDD <63 mm, and mean pulmonary arterial pressure (mPAP) <29 mmHg were predictive of normal LV function after closure.

CONCLUSION

Many adult Chinese patients developed early LV dysfunction after PDA closure and some patients developed late LV dysfunction. LVEF, LVEDD, and mPAP were identified as significant predictors of late LV systolic function.

摘要

背景

动脉导管未闭（PDA）封堵术后可发生左心室（LV）收缩功能障碍，而中国成年患者的数据尚缺。

方法

我们对在中山医院成功接受经导管PDA封堵术的成年中国患者进行了检查。在封堵术前、出院前以及封堵术后1、3、6和12个月进行超声心动图检查。2010年1月至2016年12月共纳入430例患者。根据左心室舒张末期内径（LVEDD）将患者分为两组：左心室扩大组：>56mm（n = 191）和非左心室扩大组：≤56mm（n = 239）。

结果

封堵术后即刻LVEDD和左心室射血分数（LVEF）显著降低。左心室扩大组LVEDD（-10.5% ± 7.1% vs. -4.6% ± 7.0%，P < 0.001）和LVEF（-8.9% ± 12.6% vs. -2.1% ± 8.6%，P < 0.001）的降低幅度更大。与封堵术前水平相比，左心室收缩末期内径（LVESD）保持不变（-4.0% ± 5.4%，P = 0.257；-2.6% ± 5.4%，P = 0.201）。左心室扩大组48例患者（25.1%）和非左心室扩大组7例患者（2.9%）发生晚期LV收缩功能障碍。在多变量分析中，LVEF≥60%、LVEDD<63mm和平均肺动脉压（mPAP）<29mmHg可预测封堵术后左心室功能正常。