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Circulation:房颤消融术后肺静脉狭窄,单纯球囊血管成形术or植入支架?

2016-11-06 xing.T MedSci原创

由于缺乏特异性的临床症状,所以PVS的诊断具有挑战性,需要专用进行肺静脉成像检查。PVS的两种治疗方法短期成功率并没有显著差异,但是,相比于单纯的球囊血管成形术,支架植入术可以显着降低肺静脉后续再狭窄的风险。

尽管房颤(AF)消融术后肺静脉狭窄(PVS)的发生频率有所下降,但它的发病率仍然很高。虽然其已有多种治疗策略,包括肺静脉扩张和支架置入术,但是这些干预措施对患者的长期影响仍然未知。近日,心血管领域权威杂志Circulation上发表了一篇来自美国梅奥医学中心心内科Erin A.Fender医生及其团队的研究文章,旨在评估严重PVS的发生情况,以及单独利用球囊血管成形术或植入支架治疗后再狭窄的风险。

研究者采用前瞻性、观察性研究评估了在2000年至2014年期间124例严重的PVS患者。研究者在经CT确诊的124例严重PVS患者中发现了219处肺静脉病变,102例(82%)患者在诊断时就伴有临床症状。最常见的临床症状是呼吸困难(67%)、咳嗽(45%)、疲劳(45%)和运动耐力下降(45%),27%的患者出现咯血。92处肺静脉病变进行球囊血管成形术,86处肺静脉病变进行支架植入术,41处肺静脉病变不进行任何干预。在113例接受侵入性检查的患者中,4例(3.5%)患者发生了严重的术后并发症,15例(13.3%)患者出现了轻微的术后并发症。

总体而言,42%的静脉发生再狭窄,其中包括27%接受植入支架的静脉(n=23)与支架植入术治疗和57%进行球囊血管成形术的静脉(n=52)。3年后肺静脉再狭窄总的发生率为37,其中包括49%进行球囊血管成形术的静脉及25%接受支架植入的静脉(风险比为2.77,95%可信区间为1.72-4.45,P<0.001)。对年龄、CHA2DS2-VASc评分、高血压和研究的时间周期等因素进行调整后,进行单纯的球囊血管成形术或支架植入术后肺静脉发生再狭窄的风险仍然存在显著的差异(风险比为2.46,95%可信区间为1.47-4.12,P<0.001)。

综上所述,由于缺乏特异性的临床症状,所以PVS的诊断具有挑战性,需要专门进行肺静脉成像检查。PVS的两种治疗方法短期成功率并没有显著差异,但是,相比于单纯的球囊血管成形术,支架植入术可以显著降低肺静脉后续再狭窄的风险。

原始出处:

Erin A. Fender, et al. Severe Pulmonary Vein Stenosis Resulting from Ablation
for Atrial Fibrillation: Presentation, Management and Clinical Outcomes
. Circulation. October 28, 2016. http://dx.doi.org/10.1161/CIRCULATIONAHA.116.021949

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  4. [GetPortalCommentsPageByObjectIdResponse(id=1748520, encodeId=62641e4852043, content=<a href='/topic/show?id=0217542e3cc' target=_blank style='color:#2F92EE;'>#房颤消融术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=87, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54273, encryptionId=0217542e3cc, topicName=房颤消融术)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=900236161154, createdName=yang0222, createdTime=Sat Feb 18 07:41:00 CST 2017, time=2017-02-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1718781, encodeId=1b841e1878164, content=<a href='/topic/show?id=c3cf823841e' target=_blank style='color:#2F92EE;'>#肺静脉狭窄#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=100, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82384, encryptionId=c3cf823841e, topicName=肺静脉狭窄)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8e886, createdName=仁者大医, createdTime=Mon Jan 09 10:41:00 CST 2017, time=2017-01-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2004657, encodeId=09d1200465e7c, content=<a href='/topic/show?id=4e8a5400816' target=_blank style='color:#2F92EE;'>#成形术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54008, encryptionId=4e8a5400816, topicName=成形术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7fb6449, createdName=ZGMFX24A, createdTime=Sat Nov 19 20:41:00 CST 2016, time=2016-11-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1697392, encodeId=38ba169e392b7, content=<a href='/topic/show?id=f2399910109' target=_blank style='color:#2F92EE;'>#静脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99101, 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channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54272, encryptionId=8fdb542e29e, topicName=房颤消融)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=9b30126, createdName=skhzy, createdTime=Sat Aug 05 05:41:00 CST 2017, time=2017-08-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=154856, encodeId=257e15485689, content=谢谢分享!学习了!, beContent=null, objectType=article, channel=null, level=null, likeNumber=104, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLC1BMzZWdMSPQWuib6BtQGicK8ygGBM6YakpfkRc67soFSuKbZr86enL1KggQZEZbgWSeicJibafmYfQ3AibicIHMwwicmDShfRFvvI38/0, createdBy=272a110164, createdName=laoli, createdTime=Thu Nov 10 17:29:56 CST 2016, time=2016-11-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1384361, encodeId=23fc1384361b3, content=<a href='/topic/show?id=2e956863556' target=_blank style='color:#2F92EE;'>#球囊#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=68635, encryptionId=2e956863556, topicName=球囊)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0361487, createdName=花花1366, createdTime=Tue Nov 08 00:41:00 CST 2016, time=2016-11-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1421645, encodeId=2cb81421645aa, content=<a href='/topic/show?id=4bc865819d2' target=_blank style='color:#2F92EE;'>#消融#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65819, encryptionId=4bc865819d2, topicName=消融)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1a193676008, createdName=xiangyuzhou972, createdTime=Tue Nov 08 00:41:00 CST 2016, time=2016-11-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1520330, encodeId=06441520330a3, content=<a href='/topic/show?id=7a736264553' target=_blank style='color:#2F92EE;'>#植入#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=62645, encryptionId=7a736264553, topicName=植入)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=832411313664, createdName=jiyangfei, createdTime=Tue Nov 08 00:41:00 CST 2016, time=2016-11-08, status=1, ipAttribution=)]
    2017-09-14 fusion
  5. 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status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1520330, encodeId=06441520330a3, content=<a href='/topic/show?id=7a736264553' target=_blank style='color:#2F92EE;'>#植入#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=62645, encryptionId=7a736264553, topicName=植入)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=832411313664, createdName=jiyangfei, createdTime=Tue Nov 08 00:41:00 CST 2016, time=2016-11-08, status=1, ipAttribution=)]
  6. 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channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54272, encryptionId=8fdb542e29e, topicName=房颤消融)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=9b30126, createdName=skhzy, createdTime=Sat Aug 05 05:41:00 CST 2017, time=2017-08-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=154856, encodeId=257e15485689, content=谢谢分享!学习了!, beContent=null, objectType=article, channel=null, level=null, likeNumber=104, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLC1BMzZWdMSPQWuib6BtQGicK8ygGBM6YakpfkRc67soFSuKbZr86enL1KggQZEZbgWSeicJibafmYfQ3AibicIHMwwicmDShfRFvvI38/0, createdBy=272a110164, createdName=laoli, createdTime=Thu Nov 10 17:29:56 CST 2016, time=2016-11-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1384361, encodeId=23fc1384361b3, content=<a 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status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1520330, encodeId=06441520330a3, content=<a href='/topic/show?id=7a736264553' target=_blank style='color:#2F92EE;'>#植入#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=62645, encryptionId=7a736264553, topicName=植入)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=832411313664, createdName=jiyangfei, createdTime=Tue Nov 08 00:41:00 CST 2016, time=2016-11-08, status=1, ipAttribution=)]
  7. 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createdBy=8e886, createdName=仁者大医, createdTime=Mon Jan 09 10:41:00 CST 2017, time=2017-01-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2004657, encodeId=09d1200465e7c, content=<a href='/topic/show?id=4e8a5400816' target=_blank style='color:#2F92EE;'>#成形术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54008, encryptionId=4e8a5400816, topicName=成形术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7fb6449, createdName=ZGMFX24A, createdTime=Sat Nov 19 20:41:00 CST 2016, time=2016-11-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1697392, encodeId=38ba169e392b7, content=<a href='/topic/show?id=f2399910109' target=_blank style='color:#2F92EE;'>#静脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99101, 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href='/topic/show?id=2e956863556' target=_blank style='color:#2F92EE;'>#球囊#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=68635, encryptionId=2e956863556, topicName=球囊)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0361487, createdName=花花1366, createdTime=Tue Nov 08 00:41:00 CST 2016, time=2016-11-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1421645, encodeId=2cb81421645aa, content=<a href='/topic/show?id=4bc865819d2' target=_blank style='color:#2F92EE;'>#消融#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65819, encryptionId=4bc865819d2, topicName=消融)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1a193676008, createdName=xiangyuzhou972, createdTime=Tue Nov 08 00:41:00 CST 2016, time=2016-11-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1520330, encodeId=06441520330a3, content=<a href='/topic/show?id=7a736264553' target=_blank style='color:#2F92EE;'>#植入#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=62645, encryptionId=7a736264553, topicName=植入)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=832411313664, createdName=jiyangfei, createdTime=Tue Nov 08 00:41:00 CST 2016, time=2016-11-08, status=1, ipAttribution=)]
    2016-11-10 laoli

    谢谢分享!学习了!

    0

  8. 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status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1520330, encodeId=06441520330a3, content=<a href='/topic/show?id=7a736264553' target=_blank style='color:#2F92EE;'>#植入#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=62645, encryptionId=7a736264553, topicName=植入)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=832411313664, createdName=jiyangfei, createdTime=Tue Nov 08 00:41:00 CST 2016, time=2016-11-08, status=1, ipAttribution=)]
    2016-11-08 花花1366
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    2016-11-08 jiyangfei
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