A Potential Marker for Prognosis in Giant Left Ventricular Patients Undergoing Valve Surgery.

IF 0.7 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Heart Surgery Forum Pub Date : 2023-06-19 DOI:10.1532/hsf.5623
Linglin Fan, Yuan Wu, Fei Liu, Xijie Wu
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Abstract

Background: Although many clinicians have made efforts to improve the prognosis for giant left ventricular with valve disease patients, potential markers to judge the prognosis of giant left ventricular patients undergoing valve surgery are still unknown. The purpose of this study was to explore the possible impact factors for giant left ventricle prognosis.

Methods: From September 2019 to September 2022, 75 patients with preoperative valvular disease with a giant left ventricle (left ventricular end diastolic diameter (LVEDD) >65 mm) underwent cardiac valve surgery. The changes in cardiac function one year after surgery were used to describe prognosis and analyze the potential independent factors affecting surgical prognosis. The left ventricular ejection fraction (LVEF) was considered to be recovered if it was ≥50% on follow-up echocardiography at least 6 months after the diagnosis.

Results: The cardiac function of patients with a giant left ventricular and valve disease improved. Compared with preoperation, the left ventricular end diastolic diameter (LVEDD), left ventricular end-systolic dimension (LVESD), pulmonary artery systolic pressure (PASP), NT-proBNP, and cardio thoracic ratio (CTR) were significantly decreased (p < 0.05), and the ratio of severe heart failure was decreased from 60% to 37.33%. In the univariate analyses, the preoperative NT-proBNP levels and PASP were significantly associated with the cardiac function recovery (odds ratio [OR] = 1.001, 95% CI 1.000-1.002, p = 0.027; OR = 1.092, 95% CI 1.015-1.175, p = 0.018). However, during the diagnostic test, PASP did not account for cardiac function recovery (AUROC = 0.505, 95% CI = 0.387-0.713, p = 0.531). Based on the cutoff value in the experiment, we found that a NT-proBNP >753 pg/mL (AUROC = 0.851, 95% CI = 0.757-0.946, p < 0.0001) was a potential prognostic marker for patients with a giant left ventricular valve disease.

Conclusions: We have demonstrated that an elevated preoperative NT-proBNP level is an independent predictor of cardiac function recovery in a cohort of giant left ventricular patients undergoing valve surgery, and this is the first study about this specific cohort of patients.

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巨大左心室瓣膜手术患者预后的潜在标志。
背景:尽管许多临床医生努力改善巨大左心室合并瓣膜疾病患者的预后,但判断巨大左心室瓣膜手术患者预后的潜在指标仍然未知。本研究的目的是探讨影响巨大左心室预后的可能因素。方法:2019年9月至2022年9月,对75例术前巨大左心室(左室舒张末直径(LVEDD) >65 mm)瓣膜病患者行心脏瓣膜手术。术后1年心功能变化描述预后,分析影响手术预后的潜在独立因素。左室射血分数(LVEF)如果在诊断后至少6个月的随访超声心动图上≥50%,则认为恢复。结果:巨大左室及瓣膜疾病患者心功能得到改善。与术前相比,左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)、肺动脉收缩压(PASP)、NT-proBNP、心肺比(CTR)均显著降低(p < 0.05),重度心力衰竭比例由60%降至37.33%。在单因素分析中,术前NT-proBNP水平和PASP与心功能恢复显著相关(优势比[OR] = 1.001, 95% CI 1.000-1.002, p = 0.027;OR = 1.092, 95% CI 1.015-1.175, p = 0.018)。然而,在诊断试验中,PASP不能解释心功能恢复(AUROC = 0.505, 95% CI = 0.387-0.713, p = 0.531)。根据实验的截止值,我们发现NT-proBNP >753 pg/mL (AUROC = 0.851, 95% CI = 0.757-0.946, p < 0.0001)是巨大左心室瓣膜疾病患者的潜在预后指标。结论:我们已经证明,术前NT-proBNP水平升高是接受瓣膜手术的巨大左心室患者心功能恢复的独立预测因子,这是对这一特定患者队列的首次研究。
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来源期刊
Heart Surgery Forum
Heart Surgery Forum 医学-外科
CiteScore
1.20
自引率
16.70%
发文量
130
审稿时长
6-12 weeks
期刊介绍: The Heart Surgery Forum® is an international peer-reviewed, open access journal seeking original investigative and clinical work on any subject germane to the science or practice of modern cardiac care. The HSF publishes original scientific reports, collective reviews, case reports, editorials, and letters to the editor. New manuscripts are reviewed by reviewers for originality, content, relevancy and adherence to scientific principles in a double-blind process. The HSF features a streamlined submission and peer review process with an anticipated completion time of 30 to 60 days from the date of receipt of the original manuscript. Authors are encouraged to submit full color images and video that will be included in the web version of the journal at no charge.
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