Tobias Schupp, Julian Müller, Max von Zworowsky, Mohammad Abumayyaleh, Kathrin Weidner, Jonas Rusnak, Kambis Mashayekhi, Thomas Bertsch, Ibrahim Akin, Michael Behnes
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引用次数: 1
Abstract
Objective. The study sought to assess the prognostic value of treatment with digitalis on long-term prognosis in patients with ventricular tachyarrhythmias and atrial fibrillation (AF) and/or heart failure (HF). Background. Data regarding the outcome of digitalis therapy following ventricular tachyarrhythmias is limited. Methods. A large retrospective registry was used including consecutive patients with episodes of ventricular tachycardia (VT) or fibrillation (VF) from 2002 to 2015. Patients treated with digitalis were compared to patients without. The primary prognostic endpoint was all-cause mortality at 3 years, secondary endpoints comprised a composite arrhythmic endpoint (i.e. recurrences of ventricular tachyarrhythmias, appropriate implantable cardioverter defibrillator (ICD) therapies, sudden cardiac death) and cardiac rehospitalization. Kaplan Mayer survival curves, multivariable cox regression, and time trend analyses were applied for statistics. Results. Eight hundred and thirty-one patients were included (20% treated with digitalis and 80% without). At 3 years, digitalis treatment was not associated with all-cause mortality following ventricular tachyarrhythmias (24 vs. 21%, log-rank p = .736; HR = 1.063; 95% CI 0.746-1.515; p = .736). However, digitalis therapy was associated with an increased risk of the composite arrhythmic endpoint (38 vs. 23%; log-rank p = .001; HR = 1.719; 95% CI 1.279-2.311; p = .001) and cardiac rehospitalization (31 vs. 18%; log-rank p = .001; HR = 1.829; 95% CI 1.318-2.538; p = .001), which was still evident within multivariable Cox regression analyses. Finally, digitoxin may be associated with a worse prognosis than digoxin. Conclusion. Digitalis therapy was not associated with mortality in patients with ventricular tachyarrhythmias, but with increased risk of the composite arrhythmic endpoint and cardiac rehospitalization at 3 years.
目标。该研究旨在评估洋地黄治疗对室性心动过速、心房颤动(AF)和/或心力衰竭(HF)患者长期预后的影响。背景。关于洋地黄治疗室性心动过速的结果的数据是有限的。方法。采用大型回顾性登记,包括2002年至2015年连续发生室性心动过速(VT)或心室颤动(VF)的患者。将接受洋地黄治疗的患者与未接受洋地黄治疗的患者进行比较。主要预后终点是3年的全因死亡率,次要终点包括复合心律失常终点(即室性心动过速复发、适当的植入式心律转复除颤器(ICD)治疗、心源性猝死)和心脏再住院。统计学采用Kaplan Mayer生存曲线、多变量cox回归和时间趋势分析。结果。纳入831例患者(20%给予洋地黄治疗,80%未给予)。在3年时,洋地黄治疗与室性心动过速后的全因死亡率无关(24% vs 21%, log-rank p = .736;Hr = 1.063;95% ci 0.746-1.515;p = .736)。然而,洋地黄治疗与复合心律失常终点的风险增加相关(38% vs. 23%;Log-rank p = .001;Hr = 1.719;95% ci 1.279-2.311;P = .001)和心脏再住院(31比18%;Log-rank p = .001;Hr = 1.829;95% ci 1.318-2.538;p = .001),这在多变量Cox回归分析中仍然很明显。最后,地高辛的预后可能比地高辛差。结论。洋地黄治疗与室性心动过速患者的死亡率无关,但与复合心律失常终点和3年后心脏再住院的风险增加有关。
期刊介绍:
The principal aim of Scandinavian Cardiovascular Journal is to promote cardiovascular research that crosses the borders between disciplines. The journal is a forum for the entire field of cardiovascular research, basic and clinical including:
• Cardiology - Interventional and non-invasive
• Cardiovascular epidemiology
• Cardiovascular anaesthesia and intensive care
• Cardiovascular surgery
• Cardiovascular radiology
• Clinical physiology
• Transplantation of thoracic organs