植入式心律转复除颤器患者心衰恶化和失代偿风险的相关因素

Q3 Medicine
N. B. Lebedeva, I. W. Talibullin, P. G. Parfenov, A. P. Egle, O. Barbarash
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引用次数: 0

摘要

目的分析植入心律转复除颤器(ICD)患者发生急性失代偿性心力衰竭(ADHF)风险的相关临床和国内因素,并根据库兹巴斯 ICD 患者登记资料建立预后模型。对库兹巴斯 ICD 患者登记处的 260 名左心室射血分数降低的患者(59(53;66)岁,214(82.3%)名男性)进行前瞻性随访。其中,156 名(60%)患者患有缺血性心肌病,其余为非缺血性心肌病。植入 ICD 后的平均随访时间为 4.2±2.3 年。对患者的以下基本信息进行了评估:人口统计学数据、社会地位、基础疾病史、伴随疾病、生命体征、标准临床和辅助临床参数、药物治疗。在随访期间,对所有 ADHF 病例和死亡病例进行了分析。共有 54 例(20.8%)患者死亡,其中 48 例(88.9%)死于 ADHF。在随访期间,34 名患者因 ADHF 住院,其中 13 人(38.2%)死亡。35名(13.5%)患者在入院前阶段死于在基础疾病背景下发生的急性缺血性心力衰竭(10名(27%)患者患有扩张型心肌病,1名(2.8%)患者患有风湿性二尖瓣疾病,24名(68.6%)患者患有缺血性心肌病)。因此,登记在册的 ADHF 病例共有 69 例,占总病例数的 26.5%。ADHF病例的死亡率为18.5%。预测 ADHF 风险的回归模型包括左心房大小(P=0.05)、男性(P=0.001)、NYHA 分级(P=0.0001)、左室射血分数<40%(P=0.0001)、未服用肾素-血管紧张素-醛固酮系统抑制剂(P=0.007)和胺碘酮(P=0.028)。创建模型的 ROC 曲线下面积(AUC)、灵敏度和特异性分别为 0.8%、69.2% 和 80%。已确定的一系列常规临床和异常因素可以预测 ICD 患者发生 ADHF 的风险,在决定植入 ICD 前必须考虑这些因素。应特别注意心力衰竭的强制治疗,因为这是导致 ADHF 的主要可改变风险因素。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Factors associated with the risk of progression and decompensation of heart failure in patients with an implantable cardioverter-defibrillator
Aim. To analyze clinical and anamnestic factors associated with the risk of acute decompensated heart failure (ADHF) in patients with an implanted cardioverter-defibrillator (ICD) with the development of a prognostic model based on the Kuzbass registry of patients with ICD.Material and methods. Prospective follow-up of 260 patients with reduced left ventricular ejection fraction (age 59 (53; 66) years, 214 (82,3%) men) from the Kuzbass registry of patients with ICD. Of them, 156 (60%) patients had ischemic cardiomyopathy, while the rest had non-ischemic cardiomyopathy. The mean follow-up period was 4,2±2,3 years after ICD implantation. The following basic information about patients were assessed: demographic data, social status, history of the underlying disease, concomitant diseases, vital signs, standard clinical and paraclinical parameters, drug therapy. During the follow-up period, all cases of ADHF and death were analyzed.Results. A total of 54 (20,8%) patients died, of which 48 (88,9%) died due to ADHF. During the follow-up period, 34 patients were hospitalized for ADHF, of which 13 (38,2%) died. Thirty-five (13,5%) patients died in the prehospital stage due to ADHF that developed against the background of the underlying disease (10 (27%) had dilated cardiomyopathy, 1 (2,8%) — rheumatic mitral valve disease, 24 (68,6%) — ischemic cardiomyopathy). Thus, a total of 69 cases of ADHF were registered, which accounted for 26,5% of the total group. Mortality in general group from ADHF was 18,5%. According to the Kaplan-Meier curve, most deaths occurred during the first 1,5 years of follow-up.The regression model for predicting the ADHF risk included left atrium size (p=0,05), male sex (p=0,001), NYHA class (p=0,0001), left ventricular ejection fraction <40% (p=0,0001), no intake of renin-angiotensin-aldosterone system inhibitors (p=0,007) and amiodarone (p=0,028). The area under the ROC curve (AUC), sensitivity and specificity of the created model was 0,8, 69,2% and 80%, respectively.Conclusion. A set of routine clinical and anamnestic factors has been identified that makes it possible to predict the risk of ADHF in patients with ICDs, which must be taken into account before making a decision to implant the device. Particular attention should be paid to mandatory therapy for heart failure, as the main modifiable risk factor for ADHF.
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来源期刊
Russian Journal of Cardiology
Russian Journal of Cardiology Medicine-Cardiology and Cardiovascular Medicine
CiteScore
2.20
自引率
0.00%
发文量
185
审稿时长
1 months
期刊介绍: Russian Journal of Cardiology has been issued since 1996. The language of this publication is Russian, with tables of contents and abstracts of all articles presented in English as well. Editor-in-Chief: Prof. Eugene V.Shlyakhto, President of the Russian Society of Cardiology. The aim of the journal is both scientific and practical, also with referring to organizing matters of the Society. The best of all cardiologic research in Russia is submitted to the Journal. Moreover, it contains useful tips and clinical examples for practicing cardiologists. Journal is peer-reviewed, with multi-stage editing. The editorial board is presented by the leading cardiologists from different cities of Russia.
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