药物联合主动脉介入治疗对TA-MAS合并HFrEF患者左心结构与功能的影响

Impact of interventional therapy on top of standard drug therapy on left ventricular structure and function in HFrEF patients complicating with middle aortic syndrome caused by Takayasu arteritis

目的探讨药物联合主动脉介入治疗对大动脉炎伴中段主动脉狭窄(TA-MAS)合并射血分数降低的心力衰竭(HFrEF)患者左心结构与功能的影响。方法该研究为纵向研究。连续收集2010年1月至2020年9月因TA-MAS合并HFrEF于中国医学科学院阜外医院住院接受主动脉介入治疗的患者。通过电子病历系统收集入选者的基线临床资料(包括人口统计学资料、基础治疗情况等),及介入治疗前后(术后3 d、1个月及每6个月进行随访)纽约心脏协会(NYHA)心功能分级、血N末端B型利钠肽原(NT-proBNP)水平、左心室舒张末期内径(LVEDD)、左心室射血分数(LVEF)、左心室质量指数(LVMI)等左心结构及功能指标,并进行比较。结果共入选患者10例,其中女性8例,年龄(18.4±5.0)岁,发病年龄(15.3±5.0)岁。10例患者均在激素和/或免疫抑制剂抗炎治疗的基础上给予了标准的抗心力衰竭药物治疗,但心功能仍未改善,遂行主动脉球囊扩张成形术和/或主动脉支架置入术,患者均顺利完成手术,术后随访3.3(1.3,5.6)年。术后第3天10例患者临床症状均明显改善,术后6个月NYHA心功能分级均恢复至Ⅱ级,与术前比较差异有统计学意义(P<0.05)。与术前比较,术后6个月患者血NT-proBNP水平明显降低(P=0.028),LVEDD明显减小(P=0.011)、LVMI明显减小(P=0.019)、LVEF明显升高(P<0.001);术后1年,患者血NT-proBNP水平仍明显降低(P=0.016),LVEDD仍减小(P=0.023)、LVMI仍减小(P=0.043)、LVEF仍升高(P<0.001)。结论对于TA-MAS合并HFrEF患者,药物联合主动脉介入治疗可在短期内改善左心结构与功能,长期效果有待进一步探讨。

Objective To evaluate the impact of interventional therapy on top of drug therapy on cardiac function and structure in heart failure with reduced ejection fraction(HFrEF)patients complicating with middle aortic syndrome caused by Takayasu arteritis(TA-MAS).Methods It was a retrospective longitudinal study.The data of patients with TA-MAS and HFrEF,who received interventional therapy on top of drug therapy in Fuwai Hospital from January 2010 to September 2020,were collected and analyzed.Baseline clinical data(including demographic data,basic treatment,etc.)were collected through the electronic medical record system.Changes of indexes such as New York Heart Association(NYHA)classification,N-terminal pro-brain natriuretic peptide(NT-proBNP),left ventricular end diastolic diameter(LVEDD),left ventricular ejection fraction(LVEF),left ventricular mass index(LVMI)before and after therapy were analyzed.Results A total of 10 patients were collected.There were 8 females in this patient cohort,age was(18.4±5.0)years and onset age was(15.3±5.0)years.All 10 patients received standard heart failure medication therapy in addition to hormone and/or immunosuppressive anti-inflammatory therapy,but cardiac function was not improved,so aortic balloon dilatation and/or aortic stenting were performed in these patients.The median follow-up was 3.3(1.3,5.6)years.On the third day after interventional therapy,the clinical symptoms of the 10 patients were significantly improved,NYHA classfication was restored from preoperativeⅢ/ⅣtoⅡat 6 months post intervention(P<0.05).Compared with preoperation,NT-proBNP(P=0.028),LVEDD(P=0.011)and LVMI(P=0.019)were significantly decreased,LVEF was significantly increased(P<0.001)at 6 months after operation.Compared with preoperation,NT-proBNP(P=0.016),LVEDD(P=0.023)and LVMI(P=0.043)remained decreased,LVEF remained increased(P<0.001)at 1 year after operation.Conclusion Results from short and medium term follow-up show that interventional therapy on top of heart failure drug therpay can effectively improve left cardiac function and attenuate cardiac remodeling in patients with TA-MAS comorbid with HFrEF.