肥厚型梗阻性心肌病酒精室间隔消融术后的血流动力学预测因素。
Hemodynamic Predictors of Outcome Following Alcohol Septal Ablation for Hypertrophic Obstructive Cardiomyopathy.
机构信息
Departments of Internal Medicine (M.S.A.), Mayo Clinic, Rochester, MN.
Cardiovascular Medicine (E.E.C., R.A.N., W.R.M., J.B.G., C.S.R., M.F.E.), Mayo Clinic, Rochester, MN.
出版信息
Circ Cardiovasc Interv. 2023 Aug;16(8):e013068. doi: 10.1161/CIRCINTERVENTIONS.123.013068. Epub 2023 Aug 15.
BACKGROUND
Alcohol septal ablation (ASA) is a minimally invasive treatment for drug-refractory obstructive hypertrophic cardiomyopathy. Detailed assessment of pressure changes and predictors of mortality and procedure success are not well defined.
METHODS
This is a single-center study evaluating pressure changes and predictors of mortality and procedure success in transseptal ASA. Survival analysis and predictors of mortality were assessed using the Kaplan-Meier analysis and Cox regression, respectively.
RESULTS
A total of 156 patients were included (mean age, 67.3 years; 46.8% women). Left atrial (LA) pressure and left ventricular outflow tract (LVOT) gradient decreased, whereas aortic pulse pressure (PP) increased post-ASA. Patients with lower baseline mean LA pressure (<median, 19 mm Hg), LVOT gradient reduction >82% (gradient change median), and PP increase >19% (PP change median) had superior survival. On Cox univariable regression, baseline mean LA pressure >median (19 mm Hg; hazard ratio [HR], 2.09 [95% CI, 1.05-4.18]; =0.036), residual LVOT gradient (HR, 1.02 [95% CI, 1.01-1.03]; =0.003), and LVOT gradient percent reduction <median (82%; HR, 2.92 [95% CI, 1.46-5.83]; =0.002) were predictors of mortality. When adjusting for age and sex, baseline LA v wave >median (28 mm Hg; HR, 2.36 [95% CI, 1.17-4.76]; =0.016), baseline mean LA pressure >median (19 mm Hg; HR, 2.70 [95% CI, 1.33-5.50]; =0.006), percentage reduction in gradient <median (82%; HR, 2.74 [CI, 1.37-5.50]; =0.005), and percentage increase in PP <median (19.3%; HR, 2.09 [CI, 1.05-4.16]; =0.035) predicted survival free of all-cause mortality.
CONCLUSIONS
ASA is associated with an acute decrease in the LVOT gradient and LA pressures and increase in aortic PP. Mean LA pressure, percentage decrease in LVOT gradient, and increase in PP are strong predictors of survival free of all-cause mortality following ASA and are important variables for procedural guidance.
背景
酒精室间隔消融术（ASA）是一种治疗药物难治性梗阻性肥厚型心肌病的微创方法。压力变化以及死亡率和手术成功率的预测因素尚不清楚。
方法
这是一项单中心研究，评估了经房间隔 ASA 术的压力变化以及死亡率和手术成功率的预测因素。使用 Kaplan-Meier 分析和 Cox 回归分别评估生存分析和死亡率预测因素。
结果
共纳入 156 例患者（平均年龄 67.3 岁；46.8%为女性）。ASA 术后左心房（LA）压力和左心室流出道（LVOT）梯度降低，而主动脉脉搏压（PP）升高。基线平均 LA 压较低（<中位数，19mmHg）、LVOT 梯度降低>82%（梯度变化中位数）和 PP 升高>19%（PP 变化中位数）的患者生存情况更好。在单变量 Cox 回归中，基线平均 LA 压>中位数（19mmHg；风险比 [HR]，2.09 [95%CI，1.05-4.18]；=0.036）、残余 LVOT 梯度（HR，1.02 [95%CI，1.01-1.03]；=0.003）和 LVOT 梯度百分比降低<中位数（82%；HR，2.92 [95%CI，1.46-5.83]；=0.002）是死亡率的预测因素。调整年龄和性别后，LA 波 v 最大值>中位数（28mmHg；HR，2.36 [95%CI，1.17-4.76]；=0.016）、基线平均 LA 压>中位数（19mmHg；HR，2.70 [95%CI，1.33-5.50]；=0.006）、梯度降低百分比<中位数（82%；HR，2.74 [CI，1.37-5.50]；=0.005）和 PP 升高百分比<中位数（19.3%；HR，2.09 [CI，1.05-4.16]；=0.035）预测 ASA 后全因死亡率的生存情况。
结论
ASA 与 LVOT 梯度和 LA 压力的急性降低以及主动脉 PP 的升高相关。平均 LA 压、LVOT 梯度降低百分比和 PP 升高是 ASA 后全因死亡率生存的有力预测因素，是指导手术的重要变量。
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