Esteves Ana Fátima, Brito Dulce, Rigueira Joana, Ricardo Inês, Pires Raquel, Pedro Mónica Mendes, Veiga Fátima, Pinto Fausto
Cardiology Department, Hospital de Santa Maria, CHLN, CCUL, Centro Académico de Medicina de Lisboa, Faculdade de Medicina da Universidade de Lisboa, Portugal.
Cardiology Department, Hospital de Santa Maria, CHLN, CCUL, Centro Académico de Medicina de Lisboa, Faculdade de Medicina da Universidade de Lisboa, Portugal.
Rev Port Cardiol (Engl Ed). 2018 Dec;37(12):991-998. doi: 10.1016/j.repc.2018.02.012. Epub 2018 Dec 13.
Valvular heart disease (VHD) is increasing worldwide, mostly because of aging. Percutaneous valve intervention is the preferred therapeutic option in high-risk patients.
To characterize the profiles of patients with VHD admitted to the cardiology ward at a tertiary referral center.
On the basis of ICD-9 codes for VHD, the discharge notes of 287 patients hospitalized over a 22-month period were reviewed and analyzed. One hundred characteristics were considered.
Median age was 74 (23-93) years, and 145 (51%) were male. The admissions were elective (for valve intervention) in 36%. Heart failure (HF) was the reason for urgent admissions in 29.3%. Multiple comorbidities were observed in 53% of patients. Etiology of VHD was degenerative in 68%, functional in 15.3% and rheumatic (predominantly in women and younger patients) in 8.7%. Aortic valve disease was present in 63% (aortic stenosis in 56%), and was associated with HF (p=0.004), atrial fibrillation (AF) (p=0.01), and left ventricular (LV) dilatation (p=0.003) or hypertrophy (p<0.001). Mitral valve disease (51%), mostly mitral regurgitation (degenerative or functional), predominated in women, and was associated with HF, AF, LV dilatation (p<0.001) and reduced LV ejection fraction (p=0.003). Significant tricuspid regurgitation (34.8%) associated with the presence of previously implanted cardiac devices (p<0.001). Valve intervention (mostly transcatheter aortic valve implantation) was performed in 41% of patients. Mean length of hospital stay was 12±14.3 days and overall in-hospital mortality was 9.8%.
Nowadays, the profiles of hospitalized patients with VHD are dominated by the elderly, with degenerative disease and multiple comorbidities, presenting with HF, AF and LV remodeling, who frequently undergo valve intervention, usually via a percutaneous approach. Mortality remains significant in this high-risk population.
全球范围内，心脏瓣膜病（VHD）的发病率正在上升，主要原因是人口老龄化。经皮瓣膜介入治疗是高危患者的首选治疗方案。
描述在一家三级转诊中心心内科病房住院的VHD患者的特征。
根据VHD的国际疾病分类第九版（ICD - 9）编码，对22个月期间住院的287例患者的出院记录进行回顾和分析。共考虑了100项特征。
患者年龄中位数为74（23 - 93）岁，男性145例（51%）。36%的入院是选择性的（为了瓣膜介入治疗）。心力衰竭（HF）是29.3%的紧急入院原因。53%的患者有多种合并症。VHD的病因中，退行性病变占68%，功能性病变占15.3%，风湿性病变（主要见于女性和年轻患者）占8.7%。63%的患者存在主动脉瓣疾病（其中主动脉狭窄占56%），且与HF（p = 0.004）、心房颤动（AF）（p = 0.01）以及左心室（LV）扩张（p = 0.003）或肥厚（p < 0.001）相关。二尖瓣疾病（51%），主要是二尖瓣反流（退行性或功能性），在女性中占主导，且与HF、AF、LV扩张（p < 0.001）和左心室射血分数降低（p = 0.003）相关。34.8%的患者存在严重三尖瓣反流，且与先前植入心脏装置有关（p < 0.001）。41%的患者接受了瓣膜介入治疗（主要是经导管主动脉瓣植入术）。平均住院时间为12±14.3天，总体住院死亡率为9.8%。
如今，住院的VHD患者以老年人为主，患有退行性疾病且有多种合并症，表现为HF、AF和左心室重构，经常接受瓣膜介入治疗，通常采用经皮途径。在这个高危人群中，死亡率仍然很高。
