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经导管主动脉瓣置换术后贫血发生率降低

Reduced Rate of Anemia after Transcatheter Aortic Valve Replacement.

作者信息

Eitan Amnon, Sliman Hussein, Zafrir Barak, Zissman Keren, Flugelman Moshe Y, Jaffe Ronen

机构信息

Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, 7 Michal Street, Haifa 34632, Israel.

Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3109601, Israel.

出版信息

J Clin Med. 2024 Sep 21;13(18):5606. doi: 10.3390/jcm13185606.

Abstract

We sought to evaluate changes in hemoglobin level and renal function in patients 5-12 months after transcatheter aortic valve replacement (TAVR), and to examine possible relationships between these changes. Anemia is common in older people with severe aortic stenosis (AS). The two most common etiologies for anemia in this population are iron deficiency due to gastrointestinal blood loss and renal failure. Angiodysplasia in the gastrointestinal system is a feature of AS syndrome. We collected clinical data, including hemoglobin level and renal function before and 5-12 months after TAVR in 315 consecutive patients. To examine whether calculated clinical predictors such as EuroScore 2 are associated with the persistence of anemia after TAVR, we performed multivariable correlation analysis with post-TAVR anemia as the dependent variable. The mean hemoglobin level increased significantly (from 11.76 to 12.16 g/dL, < 0.0001) 5-12 months after TAVR, and the number of patients with anemia decreased significantly (from 67.5% to 53.9%, < 0.0001). At 5-12 months following TAVR, a small reduction in estimated glomerular filtration rate was observed (from 60.05 ± 24.1 to 58.30 ± 24.50 mL/min, = 0.024). The multivariable correlation analysis did not identify clinical predictors of persistent anemia. A significant increase in hemoglobin was observed 5-12 months after TAVR, despite a reduction in renal function. Our findings imply that gastrointestinal blood loss, which occurs in patients with severe AS, is significantly reduced following TAVR.

摘要

我们试图评估经导管主动脉瓣置换术(TAVR)后5至12个月患者血红蛋白水平和肾功能的变化,并研究这些变化之间可能存在的关系。贫血在患有严重主动脉瓣狭窄(AS)的老年人中很常见。该人群中贫血的两种最常见病因是胃肠道失血导致的缺铁和肾衰竭。胃肠道系统血管发育异常是AS综合征的一个特征。我们收集了315例连续患者TAVR术前及术后5至12个月的临床资料,包括血红蛋白水平和肾功能。为了检验诸如欧洲心脏手术风险评估系统2(EuroScore 2)等计算得出的临床预测指标是否与TAVR术后贫血的持续存在相关,我们以TAVR术后贫血为因变量进行了多变量相关性分析。TAVR术后5至12个月,平均血红蛋白水平显著升高(从11.76克/分升降至12.16克/分升,P<0.0001),贫血患者数量显著减少(从67.5%降至53.9%,P<0.0001)。在TAVR术后5至12个月,观察到估计肾小球滤过率有小幅下降(从60.05±24.1降至58.30±24.50毫升/分钟,P = 0.024)。多变量相关性分析未确定持续性贫血的临床预测指标。尽管肾功能有所下降,但TAVR术后5至12个月仍观察到血红蛋白显著升高。我们的研究结果表明,严重AS患者发生的胃肠道失血在TAVR术后显著减少。

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