根据库兹巴斯登记处的前瞻性部分,心律转复除颤器植入术后心力衰竭患者不良预后的预测因素。

IF 0.5 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Kardiologiya Pub Date : 2024-04-30 DOI:10.18087/cardio.2024.4.n2370
N B Lebedeva, I V Talibullin, P G Parfenov, O L Barbarash
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引用次数: 0

摘要

目的:确定心力衰竭(HF)和植入式心律转复除颤器(ICD)患者非心律失常死亡的临床和器质性预测因素:通过电话调查以及检查医院和综合诊所数据库中的医疗记录,获得了库兹巴斯 ICD 患者登记处中 260 名心力衰竭(HF)和 ICD 患者的生死状态和死亡原因数据。随访期为 1.5 年。在植入 ICD 之前登记在册的临床和工具参数被纳入单变量和多变量逐步分析中,使用逻辑回归(定性变量)和线性回归(定量变量)计算回归系数并构建预后回归模型。利用 ROC 分析评估了所建模型的质量:在观察期间,54 名(20.8%)患者死亡。21例(38.8%)患者在医院死亡,其中15例(71.4%)的死亡原因是急性失代偿性心力衰竭,3例(14.3%)的死亡原因是心肌梗死,1例(4.7%)的死亡原因是中风,2例(9.5%)的死亡原因是肺炎。33例(61.2%)患者在院外死亡,死因均为与急性失代偿性心力衰竭相关的基础疾病:9例(27.2%)患者为扩张型心肌病;1例(3.0%)患者为风湿性二尖瓣病;23例(69.7%)患者为缺血性心肌病。根据单变量回归模型,QT 间期延长(U 2.41,P = 0.0161)、肺动脉收缩压升高(U 4.30,P = 0.0000)和超声心动图显示的左心房增大(U 2.98,P=0.0029);IIB 期 HF(OR 2.41;95% CI:1.26-4.6),NYHA III-IV 期(OR 3.03;95% CI:1.58-5.81);慢性阻塞性肺病(OR 5.24;95% CI:2.04-13.45);ICD 植入前缺乏 HF 最佳药物治疗(ODT)(OR 2.41;95% CI:1.29-4.49)。多变量分析确定了预后回归模型中最重要的因素:肺动脉收缩压超过 45 mm Hg、社会地位、慢性阻塞性肺病和缺乏治疗 HF 的 ODT:为确保 ICD 带来最大益处,在决定是否植入 ICD 之前,应考虑增加非心律失常死亡可能性的因素。应特别注意强制性心房颤动 ODT,因为这是导致预后不良的主要可改变风险因素。
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Predictors of Unfavorable Prognosis in Patients with Heart Failure After Cardioverter-Defibrillator Implantation According to the Prospective Part of the Kuzbass Registry.

Aim: Identification of clinical and instrumental predictors for non-arrhythmic death in patients with heart failure (HF) and implantable cardioverter-defibrillator (ICD).

Material and methods: Through a telephone survey and examination of medical records from hospital and polyclinic databases, data were obtained on the alive/dead status and causes of death for 260 patients with heart failure (HF) and ICD included in the Kuzbass Registry of Patients with ICD. The follow-up period was 1.5 years. Clinical and instrumental parameters entered into the registry before the ICD implantation were included in a univariate and multivariate step-by-step analysis using the logistic (for qualitative variables) and linear (for quantitative variables) regression with calculation of regression coefficients and construction of a prognostic regression model. The quality of the created model was assessed using a ROC analysis.

Results: During the observation period, 54 (20.8%) patients died. In 21 (38.8%) patients, death occurred in the hospital and was caused by acute decompensated heart failure in 15 (71.4%) patients, myocardial infarction in 3 (14.3%) patients, stroke in 1 (4.7%) patient, and pneumonia in 2 (9.5%) patients. 33 (61.2%) patients died outside the hospital; the cause of death was stated as the underlying disease associated with acute decompensated heart failure: in 9 (27.2%) patients, dilated cardiomyopathy; in 1 (3.0%) patient, rheumatic mitral disease; and in 23 (69.7%) patients, ischemic cardiomyopathy. According to the univariate regression model, the risk of death in the long-term period was increased by the QT interval prolongation (U 2.41, p = 0.0161); elevated pulmonary artery systolic pressure (U 4.30, p=0.0000) and increased left atrial size according to echocardiography (U 2.98, p=0.0029); stage IIB HF (OR 2.41; 95% CI: 1.26-4.6), NYHA III-IV (OR 3.03; 95% CI: 1.58-5.81); chronic obstructive pulmonary disease (OR 5.24; 95% CI: 2.04-13.45); and lack of optimal drug therapy (ODT) for HF before ICD implantation (OR 2.41; 95% CI: 1.29-4.49). The multivariate analysis identified the most significant factors included in the prognostic regression model: pulmonary artery systolic pressure above 45 mm Hg, social status, chronic obstructive pulmonary disease, and lack of ODT for HF.

Conclusion: To ensure a maximum benefit from ICD, the factors that increase the likelihood of non-arrhythmic death should be considered before making a decision on ICD implantation. Particular attention should be paid to mandatory ODT for HF as the main modifiable risk factor for unfavorable prognosis.

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来源期刊
Kardiologiya
Kardiologiya 医学-心血管系统
CiteScore
1.70
自引率
20.00%
发文量
94
审稿时长
3-8 weeks
期刊介绍: “Kardiologiya” (Cardiology) is a monthly scientific, peer-reviewed journal committed to both basic cardiovascular medicine and practical aspects of cardiology. As the leader in its field, “Kardiologiya” provides original coverage of recent progress in cardiovascular medicine. We publish state-of-the-art articles integrating clinical and research activities in the fields of basic cardiovascular science and clinical cardiology, with a focus on emerging issues in cardiovascular disease. Our target audience spans a diversity of health care professionals and medical researchers working in cardiovascular medicine and related fields. The principal language of the Journal is Russian, an additional language – English (title, authors’ information, abstract, keywords). “Kardiologiya” is a peer-reviewed scientific journal. All articles are reviewed by scientists, who gained high international prestige in cardiovascular science and clinical cardiology. The Journal is currently cited and indexed in major Abstracting & Indexing databases: Web of Science, Medline and Scopus. The Journal''s primary objectives Contribute to raising the professional level of medical researchers, physicians and academic teachers. Present the results of current research and clinical observations, explore the effectiveness of drug and non-drug treatments of heart disease, inform about new diagnostic techniques; discuss current trends and new advancements in clinical cardiology, contribute to continuing medical education, inform readers about results of Russian and international scientific forums; Further improve the general quality of reviewing and editing of manuscripts submitted for publication; Provide the widest possible dissemination of the published articles, among the global scientific community; Extend distribution and indexing of scientific publications in major Abstracting & Indexing databases.
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