Краткосрочные и среднесрочные результаты транскатетерного закрытия дефекта межпредсердной перегородки у пациентов старше 60 лет

Цель. Оценить краткосрочные и среднесрочные клинические и эхокардиографические исходы и выявить факторы, связанные с легочной артериальной гипертензией (ЛАГ) у пациентов старше 60 лет.

Материал и методы. В ретроспективное одноцентровое исследование был последовательно включен 51 пациент (средний возраст 63,3±3,2 года, 76% женщины), перенесшего чрескожное закрытие дефекта межпредсердной перегородки (ДМПП). Функциональный статус, ремоделирование правого желудочка (ПЖ) и систолическое давление в легочной артерии (СДЛА) оценивали до и через 24 ч после процедуры, через 6 и 12 месяцев.

Результаты. Средний размер ДМПП составил 21,8±4,4 мм. По сравнению с состоянием до процедуры, через 24 часа наблюдалось уменьшение количество пациентов с NYHA II-III с 34 (66,7%) до 7 (13,7%) (p<0,0001), размеров ПЖ с 31,3±5,7 мм до 26,9±5,7 (p<0,0001) и СДЛА с 50,4±14,2 мм до 26,9±5,7 (p<0,001). Через 1 год размер ПЖ и СДЛА уменьшились до 22±4,6 мм (p<0,0001) и 33,8±10,8 мм рт.ст., (p<0,0001), соответственно, по сравнению с данными до закрытия ДМПП. ЛАГ сохранялась у 10 (19,6%) пациентов. До вмешательства СДЛА ≥57,5 мм рт.ст. было независимым предиктором резидуальной ЛАГ через 1 год (отношение шансов 1,31, 95% доверительный интервал (ДИ) 1,04-1,67, p=0,024; C-индекс 0,939, 95% ДИ 0,865-1,0, р<0,001, чувствительность 80%, специфичность 92,6%).

Заключение. Чрескожное закрытие ДМПП у пожилых пациентов ассоци­ировалось с уменьшением размера ПЖ и СДЛА, а также снижением выраженности симптомов в краткосрочной и среднесрочной перспективе. СДЛВ до вмешательства был независимым предиктором, связанным с резидуальной ЛАГ через год.

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