Rosas Martín, Attie Fause, Sandoval Julio, Castellano Carlos, Buendía Alfonso, Zabal Carlos, Granados Nuria
Department of Adult Congenital Heart Disease, Mexico, Mexico.
Int J Cardiol. 2004 Feb;93(2-3):145-55. doi: 10.1016/S0167-5273(03)00192-X.
Although good prognosis and clinical long-term outcome have been commonly reported in minimally symptomatic adult patients with ASD, this information has been based on studies with a relatively small number of adult patients. We studied unoperated patients aged over 40 years to define the patterns of presentation, anatomical characteristics, outcome and predictive factors for free-event survival of major cardiovascular and pulmonary events.
Two-hundred survivors of atrial septal defect aged over 40-yr attended from 1985 to 1998 were reviewed and followed-up from 1.6 to 22 years. Patients were classified in three groups according to age at entry: Group 1, between 40 and 49; Group 2; 50 and 59; and Group 3, > or =60 years old. The mean age at presentation was 48.8+/-9.2 years, and the most common clinical presentations were arrhythmia and dyspnea (51.4%). There were 37 (18.5%) events: 7 heart failure-related, 5 sudden death, 13 severe pulmonary infections, 5 embolisms, and 4 strokes. According to Cox's regression analysis, predictors of primary end point included age group at presentation (hazard ratio 1.71, 95% confidence limits 1.16 to 2.54), and either pulmonary hypertension (mean pulmonary pressure >35 mmHg; hazard ratio=0.65 (4.6, confidence limits 2.2 to 9.5) or, arterial oxygen saturation <80% (hazard ratio 1.71, 95% confidence limits 1.16 to 2.54).
This study supports that long term outcome of patients aged >40 years with unoperated ASD is importantly determined by the mPAP (>35 mmHg), SaO2% (_80) and the age at diagnosis. Nevertheless we identified an inverse association between the mPAP level and SaO2% (interaction). The event-free survival expectancy may be estimated using the age at diagnosis and either SaO2% or mPAP. This prognostic stratification based on pathophysiological principles, may help in making decisions for therapeutic interventions. SaO2% should always be measured as a part of the initial clinical approach of those patients with atrial septal defect aged over 40 years.
尽管在症状轻微的成年房间隔缺损（ASD）患者中普遍报道了良好的预后和临床长期结局，但这些信息是基于相对少数成年患者的研究。我们研究了40岁以上未接受手术的患者，以确定主要心血管和肺部事件的表现模式、解剖特征、结局及自由事件生存的预测因素。
对1985年至1998年收治的200例40岁以上房间隔缺损幸存者进行回顾性研究，并随访1.6至22年。根据入组时年龄将患者分为三组：第1组，40至49岁；第2组，50至59岁；第3组，≥60岁。就诊时的平均年龄为48.8±9.2岁，最常见的临床表现为心律失常和呼吸困难（51.4%）。发生了37例（18.5%）事件：7例与心力衰竭相关，5例猝死，13例严重肺部感染，5例栓塞和4例中风。根据Cox回归分析，主要终点的预测因素包括就诊时的年龄组（风险比1.71，95%置信区间1.16至2.54），以及肺动脉高压（平均肺动脉压>35 mmHg；风险比=0.65（4.6，置信区间2.2至9.5））或动脉血氧饱和度<80%（风险比1.71，95%置信区间1.16至2.54）。
本研究支持40岁以上未接受手术的ASD患者的长期结局主要由平均肺动脉压（>35 mmHg）、动脉血氧饱和度（≤80）和诊断时年龄决定。然而，我们发现平均肺动脉压水平与动脉血氧饱和度之间存在负相关（交互作用）。可使用诊断时年龄以及动脉血氧饱和度或平均肺动脉压来估计无事件生存预期。这种基于病理生理原则的预后分层可能有助于做出治疗干预决策。对于40岁以上房间隔缺损患者，动脉血氧饱和度应始终作为初始临床检查的一部分进行测量。
