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Cardiovascular complications in patients with total cavopulmonary connection: A nationwide cohort study.
International Journal of Cardiology ( IF 3.5 ) Pub Date : 2019-12-30 , DOI: 10.1016/j.ijcard.2019.12.062
Michelle D Schmiegelow 1 , Lars Idorn 2 , Gunnar Gislason 3 , Mark Hlatky 4 , Lars Køber 5 , Christian Torp-Pedersen 6 , Lars Søndergaard 5
Affiliation  

BACKGROUND Long-term outcomes are not well established at the population level after completion of the total cavopulmonary connection (TCPC) among patients with functional univentricular hearts. PURPOSE To evaluate the incidence of cardiovascular events after TCPC completion. METHODS From a validated population-based cohort, we identified 178 patients with TCPC circulation completed after January 1, 1995. We established a comparison cohort by frequency-matching patients 1:200 on sex, and month and year of birth to the general Danish population (n = 35,600 population controls). We started follow-up at date of TCPC completion for cases and, for controls, at the index date of their matched case. The risks of cardiovascular events were assessed using cumulative incidence rates and Poisson regression models adjusted for age, sex, and calendar year. RESULTS The median age at TCPC completion was 3.3 years (interquartile range 2.6 to 5.3 years). Over a median follow-up of 12.5 years, 10 (5.6%) TCPC patients died and 7 (4.5%) had a heart transplantation compared with a 0.2% mortality in the matched population. In TCPC patients, 15.7% had an arrhythmia (11.8% supraventricular tachycardia), 3.4% had a stroke (all ischemic), and 21.4% of TCPC patients initiated a combination of a diuretic and a renin-angiotensin system (RAS)-inhibitor. These rates were >50-fold higher than in the comparison cohort: 0.2% arrhythmia, 0.06% stroke, and 0.04% starting a diuretic and a RAS-inhibitor. CONCLUSIONS Patients with TCPC circulation face a high risk of cardiovascular events during intermediate term follow-up.

中文翻译:

全腔肺连接患者的心血管并发症:一项全国队列研究。

背景技术在功能性单心室心脏患者中完成总腔肺连接(TCPC)后,在人群水平上的长期结果尚不能很好地确立。目的评估TCPC完成后心血管事件的发生率。方法从一个经过验证的人群队列中,我们鉴定了1995年1月1日之后完成的178例TCPC循环患者。我们通过按性别,以1:200的频率匹配患者,以及与丹麦一般人群的出生月份和年份的频率匹配,建立了一个比较队列。 (n = 35,600个人口控制)。我们在案例的TCPC完成日期开始跟踪,对于对照,在其匹配案例的索引日期开始跟踪。使用累积发生率和针对年龄,性别和日历年调整的Poisson回归模型评估了心血管事件的风险。结果TCPC完成时的中位年龄为3.3岁(四分位间距为2.6至5.3岁)。在12.5年的中位随访中,有10名(5.6%)TCPC患者死亡,有7名(4.5%)接受了心脏移植手术,而匹配人群的死亡率为0.2%。在TCPC患者中,有15.7%的心律不齐(11.8%的室上性心动过速),3.4%的患者有中风(全缺血),并且21.4%的TCPC患者开始使用利尿剂和肾素-血管紧张素系统(RAS)抑制剂联合治疗。这些比率比对照组高50倍以上:0.2%的心律不齐,0.06%的中风和0.04%的利尿剂和RAS抑制剂开始使用。结论TCPC循环患者在中期随访期间面临心血管事件的高风险。在12.5年的中位随访中,有10名(5.6%)TCPC患者死亡,有7名(4.5%)接受了心脏移植手术,而匹配人群的死亡率为0.2%。在TCPC患者中,有15.7%的心律不齐(11.8%的室上性心动过速),3.4%的患者有中风(全缺血),并且21.4%的TCPC患者开始使用利尿剂和肾素-血管紧张素系统(RAS)抑制剂联合治疗。这些比率比对照组高50倍以上:0.2%的心律不齐,0.06%的中风和0.04%的利尿剂和RAS抑制剂开始使用。结论TCPC循环患者在中期随访期间面临心血管事件的高风险。在12.5年的中位随访中,有10名(5.6%)TCPC患者死亡,有7名(4.5%)接受了心脏移植手术,而匹配人群的死亡率为0.2%。在TCPC患者中,有15.7%的心律不齐(11.8%的室上性心动过速),3.4%的患者患有中风(全缺血),并且21.4%的TCPC患者开始使用利尿剂和肾素-血管紧张素系统(RAS)抑制剂联合治疗。这些比率比对照组高50倍以上:0.2%的心律不齐,0.06%的中风和0.04%的利尿剂和RAS抑制剂开始使用。结论TCPC循环患者在中期随访期间面临心血管事件的高风险。7%的人患有心律不齐(11.8%的室上性心动过速),3.4%的患者患有中风(全缺血),21.4%的TCPC患者开始使用利尿剂和肾素-血管紧张素系统(RAS)抑制剂联合治疗。这些比率比对照组高50倍以上:0.2%的心律不齐,0.06%的中风和0.04%的利尿剂和RAS抑制剂开始使用。结论TCPC循环患者在中期随访期间面临心血管事件的高风险。7%的人患有心律不齐(11.8%的室上性心动过速),3.4%的患者患有中风(全缺血),21.4%的TCPC患者开始使用利尿剂和肾素-血管紧张素系统(RAS)抑制剂联合治疗。这些比率比对照组高50倍以上:0.2%的心律不齐,0.06%的中风和0.04%的利尿剂和RAS抑制剂开始使用。结论TCPC循环患者在中期随访期间面临心血管事件的高风险。
更新日期:2019-12-30
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