Moussa Nidhal Ben, Karsenty Clement, Pontnau Florence, Malekzadeh-Milani Sophie, Boudjemline Younes, Legendre Antoine, Bonnet Damien, Iserin Laurence, Ladouceur Magalie
Adult Congenital Heart Disease Unit, Cardiology Department, Hôpital Européen Georges Pompidou, France; Paediatric Cardiology, Necker Hospital, AP-HP, France; Paris Descartes University, Paris, France.
Adult Congenital Heart Disease Unit, Cardiology Department, Hôpital Européen Georges Pompidou, France; Paediatric Cardiology, Necker Hospital, AP-HP, France; Paris Descartes University, Paris, France; INSERM UMR1048, Institut des Maladies Métaboliques et Cardiovasculaires, I2MC, Equipe 8, Toulouse, France.
Arch Cardiovasc Dis. 2017 May;110(5):283-291. doi: 10.1016/j.acvd.2017.01.008. Epub 2017 Mar 14.
Heart failure (HF) is the main cause of death in adult congenital heart disease (ACHD).
We aimed to characterize HF-related hospitalization of patients with ACHD, and to determine HF risk factors and prognosis in this population.
We prospectively included 471 patients with ACHD admitted to our unit over 24 months. Clinical and biological data and HF management were recorded. Major cardiovascular events were recorded for ACHD with HF.
HF was the main reason for hospitalization in 13% of cases (76/583 hospitalizations). Patients with HF were significantly older (median age 44±14 years vs. 37±15 years; P<0.01), with more complex congenital heart disease (P=0.04). In the multivariable analysis, pulmonary arterial hypertension (odds ratio [OR] 6.2, 95% confidence interval [CI] 3.5-10.7), history of HF (OR 9.8, 95% CI 5.7-16.8) and history of atrial arrhythmia (OR 3.6, 95% CI 2.2-5.9) were significant risk factors for HF-related admissions (P<0.001). The mean hospital stay of patients with HF was longer (12.2 vs. 6.9 days; P<0.01), and 25% of patients required intensive care. Overall, 11/55 (20%) patients with HF died, 10/55 (18%) were readmitted for HF, and 6/55 (11%) had heart transplantation during the median follow-up of 18 months (95% CI 14-20 months). The risk of cardiovascular events was 19-fold higher after HF-related hospitalization.
HF is emerging as a leading cause of morbidity and mortality in the ACHD population. Earlier diagnosis and more active management are required to improve outcomes of HF in ACHD.
心力衰竭（HF）是成人先天性心脏病（ACHD）的主要死因。
我们旨在描述ACHD患者与HF相关的住院情况，并确定该人群中HF的危险因素和预后。
我们前瞻性纳入了在24个月内入住我们科室的471例ACHD患者。记录临床和生物学数据以及HF管理情况。记录合并HF的ACHD患者的主要心血管事件。
HF是13%病例（76/583次住院）住院的主要原因。HF患者年龄显著更大（中位年龄44±14岁 vs. 37±15岁；P<0.01），先天性心脏病更复杂（P=0.04）。在多变量分析中，肺动脉高压（比值比[OR] 6.2，95%置信区间[CI] 3.5 - 10.7）、HF病史（OR 9.8，95% CI 5.7 - 16.8）和房性心律失常病史（OR 3.6，95% CI 2.2 - 5.9）是与HF相关入院的显著危险因素（P<0.001）。HF患者的平均住院时间更长（12.2天 vs. 6.9天；P<0.01），25%的患者需要重症监护。总体而言，在中位随访18个月（95% CI 14 - 20个月）期间，55例HF患者中有11例（20%）死亡，10例（18%）因HF再次入院，6例（11%）接受了心脏移植。与HF相关的住院后心血管事件风险高出19倍。
HF正成为ACHD人群发病和死亡的主要原因。需要更早诊断和更积极的管理以改善ACHD中HF的结局。
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