Contemporary predictors of death and sustained ventricular tachycardia in patients with repaired tetralogy of Fallot enrolled in the INDICATOR cohort.
Contemporary predictors of death and sustained ventricular tachycardia in patients with repaired tetralogy of Fallot enrolled in the INDICATOR cohort.
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DOI：
10.1136/heartjnl-2013-304958
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发表时间：
2014-02
期刊：
影响因子：
--
通讯作者：
Geva T
中科院分区：
文献类型：
--
作者：
Valente AM;Gauvreau K;Assenza GE;Babu-Narayan SV;Schreier J;Gatzoulis MA;Groenink M;Inuzuka R;Kilner PJ;Koyak Z;Landzberg MJ;Mulder B;Powell AJ;Wald R;Geva T
法洛四联症修复术(TOF)患者成年后死亡率和发病率增加。这项研究旨在确定大量同期TOF修复术患者中死亡和室性心动过速(VT)的危险因素。研究对象来自美国、加拿大和欧洲的四个大型先天性心脏中心。分析临床、心电图、运动、心脏磁共振(CMR)和预后数据。在873例患者(中位年龄24.4 岁)中，32例(3.7%)达到了主要结果(28例死亡，4例持续室速；中位年龄38 年；中位时间为1.9 年)。COX比例风险回归分析显示，右室质量容量比≥为0.3 g/mL(HR，5.04；95%CI为2.3to11.0；p<；0.001)、LV EF z评分和−为2.0时(HR为3.34；95%CI为1.59至7.01；p=0.001)，房性快速性心律失常病史(HR为3.65；95%CI为1.75to7.62；p=0.001)为预后预测因素。右室功能障碍对预后的预测类似于左室功能障碍。在315例超声心动图评估右室收缩压的亚组分析中，较高的压力(HR 1.39；95%CI 1.19至1.62；P<；0.001)与死亡和持续性室速相关，与右室肥厚和左室功能不相关。右室肥厚、室性功能不全和房性快速性心律失常是TOF修复者死亡和持续性室速的预测指标。这些发现可能会为风险分层和未来治疗试验的设计提供参考。
Patients with repaired tetralogy of Fallot (TOF) experience increased rates of mortality and morbidity in adulthood. This study was designed to identify risk factors for death and ventricular tachycardia (VT) in a large contemporary cohort of patients with repaired TOF. Subjects with repaired TOF from four large congenital heart centres in the USA, Canada and Europe were enrolled. Clinical, ECG, exercise, cardiac magnetic resonance (CMR) and outcome data were analysed. Of the 873 patients (median age 24.4 years), 32 (3.7%) reached the primary outcome (28 deaths, 4 sustained VT; median age at outcome 38 years; median time from CMR to outcome 1.9 years). Cox proportional-hazards regression identified RV mass-to-volume ratio ≥0.3 g/mL (HR, 5.04; 95% CI 2.3 to 11.0; p<0.001), LV EF z score<−2.0 (HR, 3.34; 95% CI 1.59 to 7.01; p=0.001), and history of atrial tachyarrhythmia (HR, 3.65; 95% CI 1.75 to 7.62; p=0.001) as outcome predictors. RV dysfunction was predictive of the outcome similar to LV dysfunction. In subgroup analysis of 315 subjects with echocardiographic assessment of RV systolic pressure, higher pressure (HR 1.39; 95% CI 1.19 to 1.62; p<0.001) was associated with death and sustained VT independent of RV hypertrophy and LV dysfunction. RV hypertrophy, ventricular dysfunction and atrial tachyarrhythmias are predictive of death and sustained VT in adults with repaired TOF. These findings may inform risk stratification and the design of future therapeutic trials.
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影响因子：
37.8
作者：
Kawut SM;Barr RG;Lima JA;Praestgaard A;Johnson WC;Chahal H;Ogunyankin KO;Bristow MR;Kizer JR;Tandri H;Bluemke DA
通讯作者：
Bluemke DA
影响因子：
5.7
作者：
Knauth, A. L.;Gauvreau, K.;Geva, T.
通讯作者：
Geva, T.
影响因子：
37.8
作者：
Khairy, P;Landzberg, MJ;Walsh, EP
通讯作者：
Walsh, EP
影响因子：
2
作者：
Khairy, Paul;Dore, Annie;Mercier, Lise-Andree
通讯作者：
Mercier, Lise-Andree
DOI：
10.1016/s0735-1097(02)02344-6
发表时间：
2002-11-06
影响因子：
24
作者：
Ghai, A;Silversides, C;Therrien, J
通讯作者：
Therrien, J