Department of Cardiology, Academic Medical Center, Amsterdam, Noord-Holland, Netherlands.
Netherlands Heart Institute, Utrecht, Netherlands.
Heart. 2018 May;104(9):738-744. doi: 10.1136/heartjnl-2017-312048. Epub 2017 Nov 1.
To determine the association of pulmonary valve replacement (PVR) with death and sustained ventricular tachycardia (VT) in patients with repaired tetralogy of Fallot (rTOF).
Subjects with rTOF and cardiac magnetic resonance from an international registry were included. A PVR propensity score was created to adjust for baseline differences. PVR consensus criteria were predefined as pulmonary regurgitation >25% and ≥2 of the following criteria: right ventricular (RV) end-diastolic volume >160 mL/m, RV end-systolic volume >80 mL/m, RV ejection fraction (EF) <47%, left ventricular EF <55% and QRS duration >160 ms. The primary outcome included (aborted) death and sustained VT. The secondary outcome included heart failure, non-sustained VT and sustained supraventricular tachycardia.
In 977 rTOF subjects (age 26±15 years, 45% PVR, follow-up 5.3±3.1 years), the primary and secondary outcomes occurred in 41 and 88 subjects, respectively. The HR for subjects with versus without PVR (time-varying covariate) was 0.65 (95% CI 0.31 to 1.36; P=0.25) for the primary outcome and 1.43 (95% CI 0.83 to 2.46; P=0.19) for the secondary outcome after adjusting for propensity and other factors. In subjects (n=426) not meeting consensus criteria, the HR for subjects with (n=132) versus without (n=294) PVR was 2.53 (95% CI 0.79 to 8.06; P=0.12) for the primary outcome and 2.31 (95% CI 1.07 to 4.97; P=0.03) for the secondary outcome.
In this large multicentre rTOF cohort, PVR was not associated with a reduced rate of death and sustained VT at an average follow-up of 5.3 years. Additionally, there were more events after PVR compared with no PVR in subjects not meeting consensus criteria.
确定在修复性法洛四联症（rTOF）患者中，行肺动脉瓣置换术（PVR）与死亡和持续性室性心动过速（VT）的相关性。
本研究纳入了来自一个国际注册中心的 rTOF 患者和心脏磁共振检查资料。创建了 PVR 倾向评分，以调整基线差异。将肺动脉瓣反流>25%和以下≥2项标准定义为 PVR 共识标准：右心室（RV）舒张末期容积>160ml/m2、RV 收缩末期容积>80ml/m2、RV 射血分数（EF）<47%、左心室 EF<55%和 QRS 持续时间>160ms。主要结局包括（心源性）死亡和持续性 VT。次要结局包括心力衰竭、非持续性 VT 和持续性室上性心动过速。
在 977 例 rTOF 患者（年龄 26±15 岁，45%行 PVR，随访 5.3±3.1 年）中，41 例和 88 例患者分别发生了主要和次要结局。与未行 PVR 的患者相比，有（时间变化的协变量）和无 PVR 的患者相比，主要结局的 HR 为 0.65（95%CI 0.31 至 1.36；P=0.25），次要结局的 HR 为 1.43（95%CI 0.83 至 2.46；P=0.19），校正倾向和其他因素后。在未符合共识标准的患者（n=426）中，行 PVR 的患者（n=132）与未行 PVR 的患者（n=294）相比，主要结局的 HR 为 2.53（95%CI 0.79 至 8.06；P=0.12），次要结局的 HR 为 2.31（95%CI 1.07 至 4.97；P=0.03）。
在这项大型多中心 rTOF 队列研究中，平均随访 5.3 年后，PVR 与死亡率和持续性 VT 发生率降低无关。此外，在未符合共识标准的患者中，与未行 PVR 的患者相比，行 PVR 后发生的事件更多。
