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残余胆固醇与生物瓣退行性变进展的关系。

Association between remnant cholesterol and progression of bioprosthetic valve degeneration.

机构信息

Research Center, Institut universitaire de cardiologie et de pneumologie de Québec (Quebec Heart & Lung Institute), Université Laval, 2725 Chemin Sainte-Foy, Québec city, Québec G1V-4G5, Canada.

State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100037, People's Republic of China.

出版信息

Eur Heart J Cardiovasc Imaging. 2023 Nov 23;24(12):1690-1699. doi: 10.1093/ehjci/jead159.

DOI:10.1093/ehjci/jead159
PMID:37409985
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10667036/
Abstract

AIMS

Remnant cholesterol (RC) seems associated with native aortic stenosis. Bioprosthetic valve degeneration may share similar lipid-mediated pathways with aortic stenosis. We aimed to investigate the association of RC with the progression of bioprosthetic aortic valve degeneration and ensuing clinical outcomes.

METHODS AND RESULTS

We enrolled 203 patients with a median of 7.0 years (interquartile range: 5.1-9.2) after surgical aortic valve replacement. RC concentration was dichotomized by the top RC tertile (23.7 mg/dL). At 3-year follow-up, 121 patients underwent follow-up visit for the assessment of annualized change in aortic valve calcium density (AVCd). RC levels showed a curvilinear relationship with an annualized progression rate of AVCd, with increased progression rates when RC >23.7 mg/dL (P = 0.008). There were 99 deaths and 46 aortic valve re-interventions in 133 patients during a median clinical follow-up of 8.8 (8.7-9.6) years. RC >23.7 mg/dL was independently associated with mortality or re-intervention (hazard ratio: 1.98; 95% confidence interval: 1.31-2.99; P = 0.001).

CONCLUSION

Elevated RC is independently associated with faster progression of bioprosthetic valve degeneration and increased risk of all-cause mortality or aortic valve re-intervention.

摘要

目的

残余胆固醇（RC）似乎与原生主动脉瓣狭窄有关。生物瓣退行性变可能与主动脉瓣狭窄具有相似的脂质介导途径。我们旨在研究 RC 与生物瓣主动脉瓣退行性变进展及随后的临床结局之间的关系。

方法和结果

我们纳入了 203 例患者，这些患者在接受主动脉瓣置换术后中位数为 7.0 年（四分位间距：5.1-9.2）。RC 浓度通过 RC 最高三分位数（23.7mg/dL）进行二分法。在 3 年随访时，121 例患者接受了随访，以评估主动脉瓣钙密度（AVCd）的年化变化。RC 水平与 AVCd 的年化进展率呈曲线关系，当 RC＞23.7mg/dL 时，进展率增加（P=0.008）。在中位数为 8.8（8.7-9.6）年的临床随访中，133 例患者中有 99 例死亡，46 例主动脉瓣再干预。RC＞23.7mg/dL 与死亡率或再干预独立相关（风险比：1.98；95%置信区间：1.31-2.99；P=0.001）。

结论

升高的 RC 与生物瓣退行性变进展更快以及全因死亡率或主动脉瓣再干预的风险增加独立相关。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0f1a/10667036/7064fb7f26f4/jead159_ga1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0f1a/10667036/7064fb7f26f4/jead159_ga1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0f1a/10667036/7064fb7f26f4/jead159_ga1.jpg

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