摘要
目的:探讨主动脉瓣重度狭窄合并非对称性室间隔肥厚患者行主动脉瓣置换术后依据时间变化的左心逆重构过程以及术后残余左心室肥厚与远期预后的关系。方法:回顾性分析2007年10月至2017年2月期间阜外医院59例主动脉瓣重度狭窄合并非对称性室间隔肥厚单纯行主动脉瓣置换术的患者资料,依据术后2年的超声心动图检查结果分成左心室重量指数正常组(n=24)和残余左心室肥厚组(n=35)并进行比较,其中30例患者术前、术后早期、术后3个月、术后1年、术后2年和术后3年的超声心动图资料均可获得,用来分析依据时间变化的左心逆重构过程。结果:30例主动脉瓣重度狭窄合并非对称性室间隔肥厚患者主动脉瓣置换术后,室间隔厚度和左心室重量指数逐渐下降,2年时达到最低点,而左心房直径在术后早期就迅速下降,3个月时达到平台期。多因素Logistic回归分析提示,术前更高的左心室重量指数是术后2年残余左心室肥厚的独立危险因素(OR=3.832,95%CI:1.796~8.177,P=0.001)。Cox比例风险模型提示,术前更高的左心室重量指数是远期非致死性心原性再入院的独立危险因素(HR=2.248,95%CI:1.247~4.051,P=0.007)。Kaplan-Meier曲线提示两组患者远期免于心原性死亡率差异无统计学意义(P=0.703),但残余左心室肥厚组患者远期免于非致死性心原性再入院率显著低于左心室重量指数正常组(P=0.014)。结论:主动脉瓣重度狭窄合并非对称性室间隔肥厚的患者行主动脉瓣置换术后左心房逆重构的最佳时期是术后3个月,而左心室逆重构的最佳时期是术后2年;术前更高的左心室重量指数容易导致术后残余左心室肥厚,与远期不良事件密切相关。
Objectives:To observe the temporal pattern of reverse cardiac remodeling and evaluate the impact of residual left ventricular hypertrophy(LVH)after aortic valve replacement(AVR)on the prognosis of the patients with severe aortic stenosis(AS)and asymmetric septal hypertrophy(ASH).Methods:We retrospectively reviewed 59 consecutive patients who underwent AVR for severe AS and ASH.Patients were divided into normal left ventricular mass group(group 1,n=24)and residual LVH group(group 2,n=35)according to the left ventricular mass index(LVMI)at 2 years after AVR.30 patients were eligible for the analysis of time-dependent change of LV and LA reverse remodeling up to 3 years post operation.Results:Interventricular septal thickness(IST)and LVMI decreased gradually and reached the lowest point at 2 years after AVR,whereas LAD decreases rapidly in the early postoperative period and reaches a plateau at 3 months post AVR.Multivariable analysis identified that higher preoperative LVMI(OR=3.832,95%CI:1.796–8.177,P=0.001)was an independent predictor of residual LVH at 2 year after AVR.Multivariable Cox proportional survival analysis showed that higher preoperative LVMI(HR=2.248,95%CI:1.247–4.051,P=0.007)was the independent predictor of free from long-term non-fatal cardiovascular hospitalization.Kaplan-Meier curves showed that there were no statistical difference in terms of free from cardiovascular death between the two groups(P=0.703),but patients in group 2 had lower rate of free from non-fatal cardiovascular hospitalization than that in group 1(P=0.014).Conclusions:For patients with severe AS and ASH,maximum regression of LA diameter occurred at 3 months after AVR,whereas maximum regression of LV occurred at 2 years after AVR.Higher preoperative LVMI is an independent predictor for postoperative residual LVH,which is associated with adverse clinical outcomes.
作者
徐海涛
袁昕
孙寒松
武恒朝
宋云虎
许建屏
王巍
XU Haitao;YUAN Xin;SUN Hansong;WU Hengchao;SONG Yunhu;XU Jianping;WANG Wei(Adult Cardiac Surgery Center,National Center for Cardiovascular Diseases and Fuwai Hospital,CAMS and PUMC,Beijing(100037),China)
出处
《中国循环杂志》
CSCD
北大核心
2019年第11期1085-1090,共6页
Chinese Circulation Journal
关键词
主动脉瓣狭窄
非对称性室间隔肥厚
左心室肥厚
主动脉瓣置换术
aortic valve stenosis
asymmetric septal hypertrophy
left ventricular hypertrophy
aorticvalve replacement
