先天性心脏病患者心脏介入诊疗中低剂量电离辐射暴露：基于人群的 15 年纵向队列研究数据。
Exposure to Low-Dose Ionizing Radiation From Cardiac Procedures in Patients With Congenital Heart Disease: 15-Year Data From a Population-Based Longitudinal Cohort.
机构信息
From Department of Cardiology, Children's Hospital Boston, Harvard Medical School, MA (V.B.L., M.G.); Department of Pediatrics, Montreal Children's Hospital, McGill University, QC, Canada (V.B.L.); Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (P.R.L.); Department of Medicine, McGill University Health Center, Montreal, QC, Canada (P.R.L., L.P.); and Division of Cardiology, Jewish General Hospital (M.J.E.) and McGill Adult Unit for Congenital Heart Disease Excellence (R.I.-I., L.G., A.J.M.), McGill University, Montreal, QC, Canada.
出版信息
Circulation. 2016 Jan 5;133(1):12-20. doi: 10.1161/CIRCULATIONAHA.115.019137. Epub 2015 Nov 4.
BACKGROUND
The burden of low-dose ionizing radiation (LDIR) exposure from medical procedures among individuals with congenital heart disease (CHD) is unknown. In this longitudinal population-based study, we sought to determine exposure to LDIR-related cardiac imaging and therapeutic procedures in children and adults with CHD.
METHODS AND RESULTS
In an analysis of the Quebec CHD database, exposure to the following LDIR-related cardiac procedures was recorded: catheter-based diagnostic procedures, structural heart interventions, coronary interventions, computed tomography scans of the chest, nuclear procedures, and pacemaker/implantable cardioverter-defibrillator insertion and repair. From 1990 to 2005, there were 16 253 LDIR-exposed patients with CHD with 317 988 patient-years of available follow-up. The total number of LDIR-related procedures increased from 18.5 to 51.9 per 1000 CHD patients per year (P<0.0001). This increase was attributable to increases in rates per 1000 CHD patients in diagnostic cardiac catheterizations (11.7 to 13.7 per 1000), structural heart interventions (1.0 to 5.2 per 1000), coronary interventions (1.0 to 2.4 per 1000), pacemaker/implantable cardioverter-defibrillator insertions (1.6 to 4.4 per 1000), nuclear procedures (4.2 to 13.8 per 1000), and computed tomography scans of the chest (2.5 to 12.3 per 1000). Over time, among children with CHD, the median age at first LDIR procedure decreased from 5.0 years to 9.6 months. Severity of CHD significantly predicted extent of exposure.
CONCLUSIONS
From 1990 to 2005, patients with CHD were exposed to increasing numbers of LDIR-emitting cardiac procedures. This exposure occurred at progressively younger ages. These findings provide an important perspective on longitudinal LDIR exposure in this at-risk population.
背景
患有先天性心脏病（CHD）的个体接受医疗程序的低剂量电离辐射（LDIR）暴露负担尚不清楚。在这项基于人群的纵向研究中，我们旨在确定 CHD 患儿和成人接受与 LDIR 相关的心脏成像和治疗程序的情况。
方法和结果
在对魁北克 CHD 数据库的分析中，记录了以下与 LDIR 相关的心脏程序的暴露情况：基于导管的诊断程序、结构性心脏介入、冠状动脉介入、胸部计算机断层扫描、核程序以及起搏器/植入式心律转复除颤器的插入和修复。1990 年至 2005 年，有 16253 名接受 LDIR 暴露的 CHD 患者，随访时间为 317988 患者年。与 LDIR 相关的程序总数从每年每 1000 例 CHD 患者 18.5 例增加到 51.9 例（P<0.0001）。这种增加归因于每 1000 例 CHD 患者的发生率增加，包括诊断性心脏导管检查（从每 1000 例 11.7 例增加到 13.7 例）、结构性心脏介入（从每 1000 例 1.0 例增加到 5.2 例）、冠状动脉介入（从每 1000 例 1.0 例增加到 2.4 例）、起搏器/植入式心律转复除颤器插入（从每 1000 例 1.6 例增加到 4.4 例）、核程序（从每 1000 例 4.2 例增加到 13.8 例）以及胸部计算机断层扫描（从每 1000 例 2.5 例增加到 12.3 例）。随着时间的推移，CHD 患儿首次接受 LDIR 治疗的中位年龄从 5.0 岁降至 9.6 个月。CHD 的严重程度显著预测了暴露的程度。
结论
1990 年至 2005 年，CHD 患者接受了越来越多的 LDIR 放射性心脏程序。这种暴露发生在年龄越来越小的患者中。这些发现为该高危人群的纵向 LDIR 暴露提供了重要视角。
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