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JACC:中度主动脉瓣混合性病变(MAVD)患者预后较差

2016-05-18 崔倩 译 MedSci原创

目前研究还没有直接比较中度主动脉瓣混合性病变(MAVD)和单独的主动脉瓣狭窄(AS)或主动脉瓣关闭不全(AR)的结果,这使得MAVD患者循证建议困难。这项研究旨在确定不良事件(AE)的发生(主要终点),定义为纽约心脏协会功能分级III/ IV症状,主动脉瓣置换术,或心源性死亡,并比较MAVD和单独AS或AR之间的AE率,。无症状的患者被确定中度MAVD,并且射血分数≥50%,并从1994年到201

目前研究还没有直接比较中度主动脉瓣混合性病变(MAVD)和单独的主动脉瓣狭窄(AS)或主动脉瓣关闭不全(AR)的结果,这使得MAVD患者循证建议困难。

这项研究旨在确定不良事件(AE)的发生(主要终点),定义为纽约心脏协会功能分级III/ IV期、主动脉瓣置换术或心源性死亡,并比较MAVD和单独AS或AR之间的AE率。

无症状且射血分数≥50%的患者被确定中度MAVD,从1994年到2013年在梅奥诊所进行随访。中度MAVD被定义为中度AS和中度AR的组合。研究人员对单独的中度AR(n=117)、中度AS(n=117)或重度AS(n=117)患者筛选了年龄和性别匹配的对照组。

在9.1±4.2年随访时,中度MAVD(n=251)患者平均年龄63±11岁,73%为男性,38%有二尖瓣。该组患者有193例(77%)发生AE,包括症状发展(69%),主动脉瓣置换(67%),和心源性死亡(4%)。AE的预测因素为年龄(危险比[HR]:每十年1.71; 95%可信区间(CI):每十年1.38至1.97; p=0.001),相对室壁厚度>0.42(HR:2.01; 95%CI :1.86至2.33; p=0.002)。AE率在MAVD组和严重AS组是相似的(5年时71% vs 68%; p=0.49),但都显著高于中度AS和AR组。

MAVD患者与那些严重AS、保留射血分数患者的预后类似,应该密切监测其症状发展。

原始出处:

Alexander C. Egbe,Sushil A. Luis,Ratnasari Padang,et al.Outcomes in Moderate Mixed Aortic Valve Disease,JACC,2016.5.17

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    2016-09-15 hbwxf
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    2017-02-28 jj000001
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  5. [GetPortalCommentsPageByObjectIdResponse(id=1853526, encodeId=1cce1853526b3, content=<a href='/topic/show?id=48351020537' target=_blank style='color:#2F92EE;'>#JACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10205, encryptionId=48351020537, topicName=JACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=55ce62, createdName=hbwxf, createdTime=Thu Sep 15 00:49:00 CST 2016, time=2016-09-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1691876, encodeId=dada16918e6b6, content=<a href='/topic/show?id=a450530853c' target=_blank style='color:#2F92EE;'>#患者预后#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=53085, encryptionId=a450530853c, topicName=患者预后)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8f4729287700, createdName=bnurmamat, createdTime=Thu Jul 14 22:49:00 CST 2016, time=2016-07-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2079881, encodeId=3ed420e98819d, content=<a href='/topic/show?id=88de11331ba' target=_blank style='color:#2F92EE;'>#MAVD#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11331, encryptionId=88de11331ba, topicName=MAVD)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8942242, createdName=jj000001, createdTime=Tue Feb 28 22:49:00 CST 2017, time=2017-02-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1325239, encodeId=9f401325239f9, content=<a href='/topic/show?id=96c71804b7' target=_blank style='color:#2F92EE;'>#ACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1804, encryptionId=96c71804b7, topicName=ACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1e452500029, createdName=12498568m50暂无昵称, createdTime=Fri May 20 04:49:00 CST 2016, time=2016-05-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1332394, encodeId=bba6133239410, content=<a href='/topic/show?id=1dd6231822d' target=_blank style='color:#2F92EE;'>#主动脉瓣#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23182, encryptionId=1dd6231822d, topicName=主动脉瓣)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=dc4b2500077, createdName=hittouch, createdTime=Fri May 20 04:49:00 CST 2016, time=2016-05-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1352934, encodeId=82731352934ca, content=<a href='/topic/show?id=3ee33029dd' target=_blank style='color:#2F92EE;'>#AVD#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3029, encryptionId=3ee33029dd, topicName=AVD)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Fri May 20 04:49:00 CST 2016, time=2016-05-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1415046, encodeId=4c361415046b4, content=<a href='/topic/show?id=04812314540' target=_blank style='color:#2F92EE;'>#主动脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23145, encryptionId=04812314540, topicName=主动脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=77603112682, createdName=circumcision, createdTime=Fri May 20 04:49:00 CST 2016, time=2016-05-20, status=1, ipAttribution=)]
  6. [GetPortalCommentsPageByObjectIdResponse(id=1853526, encodeId=1cce1853526b3, content=<a href='/topic/show?id=48351020537' target=_blank style='color:#2F92EE;'>#JACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10205, encryptionId=48351020537, topicName=JACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=55ce62, createdName=hbwxf, createdTime=Thu Sep 15 00:49:00 CST 2016, time=2016-09-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1691876, encodeId=dada16918e6b6, content=<a href='/topic/show?id=a450530853c' target=_blank style='color:#2F92EE;'>#患者预后#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=53085, encryptionId=a450530853c, topicName=患者预后)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8f4729287700, createdName=bnurmamat, createdTime=Thu Jul 14 22:49:00 CST 2016, time=2016-07-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2079881, encodeId=3ed420e98819d, content=<a href='/topic/show?id=88de11331ba' target=_blank style='color:#2F92EE;'>#MAVD#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11331, encryptionId=88de11331ba, topicName=MAVD)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8942242, createdName=jj000001, createdTime=Tue Feb 28 22:49:00 CST 2017, time=2017-02-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1325239, encodeId=9f401325239f9, content=<a href='/topic/show?id=96c71804b7' target=_blank style='color:#2F92EE;'>#ACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1804, encryptionId=96c71804b7, topicName=ACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1e452500029, createdName=12498568m50暂无昵称, createdTime=Fri May 20 04:49:00 CST 2016, time=2016-05-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1332394, encodeId=bba6133239410, content=<a href='/topic/show?id=1dd6231822d' target=_blank style='color:#2F92EE;'>#主动脉瓣#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23182, encryptionId=1dd6231822d, topicName=主动脉瓣)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=dc4b2500077, createdName=hittouch, createdTime=Fri May 20 04:49:00 CST 2016, time=2016-05-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1352934, encodeId=82731352934ca, content=<a href='/topic/show?id=3ee33029dd' target=_blank style='color:#2F92EE;'>#AVD#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3029, encryptionId=3ee33029dd, topicName=AVD)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Fri May 20 04:49:00 CST 2016, time=2016-05-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1415046, encodeId=4c361415046b4, content=<a href='/topic/show?id=04812314540' target=_blank style='color:#2F92EE;'>#主动脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23145, encryptionId=04812314540, topicName=主动脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=77603112682, createdName=circumcision, createdTime=Fri May 20 04:49:00 CST 2016, time=2016-05-20, status=1, ipAttribution=)]
    2016-05-20 zhaojie88
  7. [GetPortalCommentsPageByObjectIdResponse(id=1853526, encodeId=1cce1853526b3, content=<a href='/topic/show?id=48351020537' target=_blank style='color:#2F92EE;'>#JACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10205, encryptionId=48351020537, topicName=JACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=55ce62, createdName=hbwxf, createdTime=Thu Sep 15 00:49:00 CST 2016, time=2016-09-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1691876, encodeId=dada16918e6b6, content=<a href='/topic/show?id=a450530853c' target=_blank style='color:#2F92EE;'>#患者预后#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=53085, encryptionId=a450530853c, topicName=患者预后)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8f4729287700, createdName=bnurmamat, createdTime=Thu Jul 14 22:49:00 CST 2016, time=2016-07-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2079881, encodeId=3ed420e98819d, content=<a href='/topic/show?id=88de11331ba' target=_blank style='color:#2F92EE;'>#MAVD#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11331, encryptionId=88de11331ba, topicName=MAVD)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8942242, createdName=jj000001, createdTime=Tue Feb 28 22:49:00 CST 2017, time=2017-02-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1325239, encodeId=9f401325239f9, content=<a href='/topic/show?id=96c71804b7' target=_blank style='color:#2F92EE;'>#ACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1804, encryptionId=96c71804b7, topicName=ACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1e452500029, createdName=12498568m50暂无昵称, createdTime=Fri May 20 04:49:00 CST 2016, time=2016-05-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1332394, encodeId=bba6133239410, content=<a href='/topic/show?id=1dd6231822d' target=_blank style='color:#2F92EE;'>#主动脉瓣#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23182, encryptionId=1dd6231822d, topicName=主动脉瓣)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=dc4b2500077, createdName=hittouch, createdTime=Fri May 20 04:49:00 CST 2016, time=2016-05-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1352934, encodeId=82731352934ca, content=<a href='/topic/show?id=3ee33029dd' target=_blank style='color:#2F92EE;'>#AVD#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3029, encryptionId=3ee33029dd, topicName=AVD)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Fri May 20 04:49:00 CST 2016, time=2016-05-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1415046, encodeId=4c361415046b4, content=<a href='/topic/show?id=04812314540' target=_blank style='color:#2F92EE;'>#主动脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23145, encryptionId=04812314540, topicName=主动脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=77603112682, createdName=circumcision, createdTime=Fri May 20 04:49:00 CST 2016, time=2016-05-20, status=1, ipAttribution=)]
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