Influence of pregnancy on the risk for cardiac events in patients with hereditary long QT syndrome. LQTS Investigators.
Influence of pregnancy on the risk for cardiac events in patients with hereditary long QT syndrome. LQTS Investigators.
复制标题
妊娠对遗传性长 QT 综合征患者心脏事件风险的影响。
DOI：
10.1161/01.cir.97.5.451
复制
发表时间：
1998
期刊：
影响因子：
37.8
通讯作者：
Andrews,M
中科院分区：
文献类型：
--
作者：
Rashba,EJ;Zareba,W;Moss,AJ;Hall,WJ;Robinson,J;Locati,EH;Schwartz,PJ;Andrews,M
背景-怀孕对患有遗传性长QT综合征的女性的影响目前尚不清楚。适当的医疗管理孕妇与长QT syndrome has not been established.Methods和Results-The study was a retrospective analysis of the 422 women（111 probands affected with the long QT syndrome and 311 first-degree relatives）enrolled in the long QT syndrome registry who had one or more pregnancy.一级亲属分为受累（QTc >0.47）、临界（QTc=0.45 - 0.47）和未受累（QTc <0.45）。心脏事件定义为长QT综合征相关死亡、心脏骤停流产和晕厥的合并发生率。在相同的孕前、孕期和产后间隔（各40周）内比较心脏事件的发生率。采用混合效应模型进行多变量logistic回归分析，以确定先证者心脏事件的独立预测因素。妊娠和产后间隔与一级亲属的心脏事件无关。在先证者中，产后间隔与心脏事件独立相关（比值比[OR]，40.8; 95%可信区间[CI]，3.1 - 540;P= 0.01）;妊娠间隔与心脏事件无关。β-肾上腺素能阻滞剂治疗与先证者心脏事件风险降低独立相关（OR，0.023; 95%CI，0.001 - 0.44;P= 0.01）.结论：产后间隔与长QT综合征先证者心脏事件风险显著增加相关，但与一级亲属无关。对于长QT综合征先证者，在妊娠期和产后期间应继续使用β-肾上腺素能阻滞剂进行预防性治疗。
Background—The effects of pregnancy on women with the hereditary long QT syndrome are currently unknown. The appropriate medical management of pregnant patients with the long QT syndrome has not been established.Methods and Results—The study was a retrospective analysis of the 422 women (111 probands affected with the long QT syndrome and 311 first-degree relatives) enrolled in the long QT syndrome registry who had one or more pregnancies. The first-degree relatives were classified as affected (QTc >0.47), borderline (QTc=0.45 to 0.47), and unaffected (QTc <0.45). Cardiac events were defined as the combined incidence of long QT syndrome–related death, aborted cardiac arrest, and syncope. The incidence of cardiac events was compared during equal prepregnancy, pregnancy, and postpartum intervals (40 weeks each). Multivariate logistic regression analysis was performed by use of a mixed-effects model to identify independent predictors of cardiac events among probands. The pregnancy and postpartum intervals were not associated with cardiac events among first-degree relatives. The postpartum interval was independently associated with cardiac events among probands (odds ratio [OR], 40.8; 95% confidence interval [CI], 3.1 to 540;P=.01); the pregnancy interval was not associated with cardiac events. Treatment with β-adrenergic blockers was independently associated with a decrease in the risk for cardiac events among probands (OR, 0.023; 95% CI, 0.001 to 0.44;P=.01).Conclusions—The postpartum interval is associated with a significant increase in risk for cardiac events among probands with the long QT syndrome but not among first-degree relatives. Prophylactic treatment with β-adrenergic blockers should be continued during the pregnancy and postpartum intervals in probands with the long QT syndrome.