Peak oxygen uptake, ventilatory efficiency and QRS-duration predict event free survival in patients late after surgical repair of tetralogy of Fallot
Peak oxygen uptake, ventilatory efficiency and QRS-duration predict event free survival in patients late after surgical repair of tetralogy of Fallot
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DOI：
10.1016/j.ijcard.2015.05.174
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发表时间：
2015-10-01
影响因子：
3.5
通讯作者：
Giardini, Alessandro
中科院分区：
文献类型：
--
作者：
Mueller, Jan;Hager, Alfred;Giardini, Alessandro
目的：法洛四联症（ToF）修复术后患者心血管病发病率和死亡率的长期风险增加。在这一人群中进行风险分层是困难的。初步证据表明，心肺运动试验（CPET）可能有助于风险分层患者修复ToF.Methods和结果：我们研究了875例手术修复后的ToF（358名女性，年龄25.5 +/- 11.7岁，范围7-75岁）谁接受了CPET在1999年和2009年之间。在CPET后平均4.1 +/- 2.6年的随访期间，30例患者（3.4%）死亡或持续性室性心动过速（VT）。225例患者（25.7%）发生其他心脏相关事件（急诊入院、手术或导管介入）。在多变量考克斯回归分析中，%预测峰值摄氧量（（V）超过点O2%）（p = 0.001）、静息QRS持续时间（p = 0.030）和年龄（p < 0.001）是死亡率或持续性VT的独立预测因素。峰值（V）超过点O2 = 170 ms的患者死亡或持续性VT的风险为11.4倍。通气效率表示为（V）超过点E/（V）超过点CO2斜率（p= 31.0，峰值（V）超过点O2%= 170 ms是检测不利结果的最佳灵敏度和特异性的截止点。CPET是一种重要的预测工具，可能有助于ToF患者的风险分层。除QRS持续时间延长外，运动能力差的受试者死亡或持续性室性心动过速以及心脏相关住院的风险显著增加。(C)2015爱思唯尔爱尔兰有限公司版权所有。
Objective: Patients with repaired tetralogy of Fallot (ToF) have an increased long-term risk of cardiovascular morbidity and mortality. Risk stratification in this population is difficult. Initial evidence suggests that cardiopulmonary exercise testing (CPET) may be helpful to risk-stratify patients with repaired ToF.Methods and results: We studied 875 patients after surgical repair for ToF (358 females, age 25.5 +/- 11.7 year, range 7-75 years) who underwent CPET between 1999 and 2009. During a mean follow-up of 4.1 +/- 2.6 years after CPET, 30 patients (3.4%) died or had sustained ventricular tachycardia (VT). 225 patients (25.7%) had other cardiac related events (emergency admission, surgery, or catheter interventions). On multivariable Cox regression-analysis, % predicted peak oxygen uptake ((V) over dot O2 %) (p = 0.001), resting QRS duration (p = 0.030) and age (p < 0.001) emerged as independent predictors of mortality or sustained VT. Patients with a peak (V) over dot O2 = 170 ms had a 11.4-fold risk of death or sustained VT.Ventilatory efficiency expressed as (V) over dot E/(V) over dot CO2slope (p= 31.0, peak(V) over dot O2 % = 170 ms were the cut-off points with best sensitivity and specificity to detect an unfavorable outcome.Conclusions: CPET is an important predictive tool that may assist in the risk stratification of patients with ToF. Subjects with a poor exercise capacity in addition to a prolonged QRS duration have a substantially increased risk for death or sustained ventricular tachycardia, as well as for cardiac-related hospitalizations. (C) 2015 Elsevier Ireland Ltd. All rights reserved.