摘要
目的评估肥厚梗阻性心肌病外科治疗后心血管不良事件的发生率和危险因素。方法 2002年1月至2014年12月,连续623例肥厚梗阻性心肌病患者在阜外医院成人外科中心接受外科治疗。根据回顾性资料和随访结果,建立术后心血管不良事件的术前变量风险回归模型进行分析。结果 8例(1.3%)患者院内死亡。593例(95.2%)患者完成随访,平均随访32±30个月(3~150个月),1年、5年、8年生存率为98.3%、90%、87.4%;75例患者出现终点事件(肥厚型心肌病相关性死亡,因缺血性脑卒中、快速性心律失常和心力衰竭再住院,心脏移植)。1年、5年、8年终点事件免除率为94.6%、77.6%、68%;单因素和多因素Cox回归分析显示左室射血分数<55%(HR=6.65,P<0.001),完全性右束支传导阻滞(HR=2.91,P=0.014),术前房颤(HR=2.53,P=0.001),严重冠心病(HR=1.98,P=0.025)和年龄≥50岁(HR=1.88,P=0.018)影响预后。结论除了先前报道的年龄≥50岁和术前房颤外,本研究显示射血分数<55%、完全性右束支传导阻滞和严重冠心病也是肥厚型梗阻性心肌病患者行外科治疗后心血管不良事件的独立预测因子。
Objective To evaluate the incidence and risk factors of cardiovascular adverse events after surgical treatment of hypertrophic obstructive cardiomyopathy. Methods From January 2002 to December 2014, 623 consecutive patients with hypertrophic obstructive cardiomyopathy underwent operations at Adult Surgery Center in Fuwai Hospital. Based on retrospective data and follow-up results, the preoperative risk regression model of postoperative cardiovascular adverse events was established. Results The operative mortality was 1.3%. 593 patients（95.2%） were followed-up for a mean period of 32±30 months. Overall survival for 1, 5 and 8 years was 98.3%, 90%, 87.4%, respectively. 75 patients had an adverse end-piont events including death related to hypertrophic cardiomyopathy, heart transplantation and due to ischemic stroke, tachyarrhythmia and heart failure requiring inpatient hospitalization during follow-up. Freedom from end-point events at 1, 5 and 8 years was 94.6%, 77.6%, 68%, respectively. Using univariant and multivariant Cox regression model, left ventricular ejection fraction（LVEF）55%（HR=6.65, P〈0.001）, complete right bundle branch block（CRBBB）（HR=2.91, P =0.014）, prior atrial fibrillation（HR=2.53, P =0.001）, severe obstructive coronary artery disease（CAD）（HR=1.98, P =0.025） and age≥50 ys（HR=1.88, P =0.018） affect prognosis. Conclusions In addition to previously reported factors including age≥ 50 ys and prior atrial fibrillation, our study showed that LVEF55%, CRBBB and severe obstructive CAD were also independent predictors of cardiovascular adverse events on follow-up.
作者
李浩杰
宋云虎
唐亚捷
邓隆
王水云
高歌
LI Hao-Jie;SONG Yun-hu;TANG Ya-Jie;DENG Long;WANG Shui- Yun;GAO Ge.(Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 10037, China.)
出处
《中国分子心脏病学杂志》
CAS
2018年第1期2342-2345,共4页
Molecular Cardiology of China
关键词
肥厚型心肌病
外科
不良事件
风险因子
Hypertrophic Cardiomyopathy
Surgery
End Point Events
Risk Factor
