Does Survival on the Heart Transplant Waiting List Depend on the Underlying Heart Disease?
Does Survival on the Heart Transplant Waiting List Depend on the Underlying Heart Disease?
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DOI：
10.1016/j.jchf.2016.03.010
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发表时间：
2016-09-01
影响因子：
13
通讯作者：
Schold, Jesse D.
中科院分区：
文献类型：
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作者：
Hsich, Eileen M.;Rogers, Joseph G.;Schold, Jesse D.
背景限制性心肌病(RCM)、先天性心脏病(CHD)或肥厚型心肌病(HCM)患者在等待OHT时可能处于不利地位，因为他们往往不适合接受机械循环支持和/或肌力支持。方法本研究纳入2004年至2014年等待OHT的所有成年人，并根据心脏疾病的类型进行评估。主要终点是所有原因死亡的时间，最后对患者的随访和移植时间进行审查。结果14,447例DCM患者，823例RCM患者，11,799例缺血性心肌病(ICM)患者，602例HCM患者，964例CHD患者，584例瓣膜疾病患者，1,528例“其他”患者(包括1216例再次移植)。在3.7个月的中位随访期间，4943名患者死亡(1253名女性，3690名男性)。在调整了年龄、肾功能、向力性、机械通气和机械循环支持等可能的混杂变量后，诊断为扩张型心肌病的调整风险比为1.70(95%可信区间：1.43~2.02)，调整后的危险比为1.10(95%CI：1.03~1.18)，1.23(95%CI：0.98~1.54)，1.30(95%CI：1.07~1.57)，1.37(95%CI：1.17~1.61)，“其他”诊断为1.51(95%CI：1.34~1.69)。性别是ICM、RCM和“其他”诊断死亡率的重要影响因素(交互作用P<；0.05)。结论在美国，RCM、CHD或既往心脏移植患者在等待OHT期间死亡的风险高于DCM、ICM、HCM或瓣膜心脏病患者。(C)2016年，由美国心脏病学院基金会提供。
OBJECTIVES The aim of this study was to identify differences in survival on the basis of type of heart disease while awaiting orthotopic heart transplantation (OHT).BACKGROUND Patients with restrictive cardiomyopathy (RCM), congenital heart disease (CHD), or hypertrophic cardiomyopathy (HCM) may be at a disadvantage while awaiting OHT because they often are poor candidates for mechanical circulatory support and/or inotropes.METHODS The study included all adults in the Scientific Registry of Transplant Recipients database awaiting OHT from 2004 to 2014, and outcomes were evaluated on the basis of type of heart disease. The primary endpoint was time to all cause mortality, censored at last patient follow-up and time of transplantation. Multivariate Cox proportional hazards modeling was performed to evaluate survival by type of cardiomyopathy.RESULTS There were 14,447 patients with DCM, 823 with RCM, 11,799 with ischemic cardiomyopathy (ICM), 602 with HCM, 964 with CHD, 584 with valvular disease, and 1,528 in the "other" category (including 1,216 for retransplantation). During median follow-up of 3.7 months, 4,943 patients died (1,253 women, 3,690 men). After adjusting for possible confounding variables including age, renal function, inotropes, mechanical ventilation, and mechanical circulatory support, the adjusted hazard ratios by diagnoses relative to DCM were 1.70 for RCM (95% confidence interval [CI]: 1.43 to 2.02), 1.10 for ICM (95% CI: 1.03 to 1.18), 1.23 for HCM (95% CI: 0.98 to 1.54), 1.30 for valvular disease (95% CI: 1.07 to 1.57), 1.37 for CHD (95% CI: 1.17 to 1.61), and 1.51 for "other" diagnoses (95% CI: 1.34 to 1.69). Sex was a significant modifier of mortality for ICM, RCM, and "other" diagnoses (p < 0.05 for interaction).CONCLUSIONS In the United States, patients with RCM, CHD, or prior heart transplantation had a higher risk for death while awaiting OHT than patients with DCM, ICM, HCM, or valvular heart disease. (C) 2016 by the American College of Cardiology Foundation.