Ullah Waqas, Sattar Yasar, Rauf Hiba, Roomi Sohaib, Shah Murtaza Ishaq
Internal Medicine, Abington Hospital - Jefferson Health, Abington, USA.
Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, USA.
Cureus. 2019 Dec 13;11(12):e6371. doi: 10.7759/cureus.6371.
Cor triatriatum is a rare congenital cardiac condition characterized by the division of one atrium into two chambers by a fibromuscular membrane, resulting in three atrial chambers. The goal of this study was to determine the associations of cor triatriatum with cyanosis, atrial fibrillation (AF), and stroke. MEDLINE (PubMed, Ovid), Embase, and Cochrane databases were searched on April 25, 2019, for relevant articles on cor triatriatum. After initial screening and removal of duplicates, 235 articles were selected. Data were extracted from these articles, including types, presentations, diagnostic findings, management, and outcomes of patients with cor triatriatum. Approximately 83% of patients with cor triatriatum had cor triatriatum sinistrum (CTS) and 17% had cor triatriatum dextrum (CTD). The mean age of all patients was 29±23 years. Mean ages at diagnosis differed significantly in patients with CTS and CTD (31±23 years vs. 21±20 years, p=0.02). CTS showed a significantly greater association with AF (14.65% vs. 12.5%, p=0.036) and had a substantially higher risk of stroke (7.9% vs. 5.0%, p=0.04) than CTD. CTS also had a numerically higher association with atrial septal defects (15.13% vs. 15.6%), but this difference was not statistically significant (p=0.89). In contrast, cyanosis at presentation was significantly more frequent in patients with CTD than CTS (5.5% vs. 5.3%, p=0.05). Management did not differ significantly between these groups (p=0.29). The overall mortality rate was 16%, with no significant difference between patients with CTS and CTD (p=0.33). The higher likelihood of AF and stroke in CTS than in CTD patients warrants treatment of the former with anticoagulation agents, irrespective of their CHA₂DS₂-VASc scores (congestive heart failure, hypertension, age, diabetes mellitus, stroke, vascular disease, age, sex category). Patients with CTS usually present at an older age due to their lower risk of cyanosis and asymptomatic AF.
三房心是一种罕见的先天性心脏疾病，其特征是一个心房被纤维肌膜分隔为两个腔室，从而形成三个心房腔。本研究的目的是确定三房心与发绀、心房颤动（AF）和中风之间的关联。于2019年4月25日在MEDLINE（PubMed、Ovid）、Embase和Cochrane数据库中检索有关三房心的相关文章。经过初步筛选和去除重复项后，共选取了235篇文章。从这些文章中提取数据，包括三房心患者的类型、临床表现、诊断结果、治疗及预后。约83%的三房心患者为左位三房心（CTS），17%为右位三房心（CTD）。所有患者的平均年龄为29±23岁。CTS和CTD患者的诊断时平均年龄差异显著（31±23岁 vs. 21±20岁，p = 0.02）。与CTD相比，CTS与AF的关联显著更强（14.65% vs. 12.5%，p = 0.036），且中风风险显著更高（7.9% vs. 5.0%，p = 0.04）。CTS与房间隔缺损的关联在数值上也更高（15.13% vs. 15.6%），但差异无统计学意义（p = 0.89）。相比之下，CTD患者出现发绀的频率显著高于CTS患者（5.5% vs. 5.3%，p = 0.05）。两组间的治疗方法差异无统计学意义（p = 0.29）。总死亡率为16%．CTS和CTD患者之间无显著差异（p = 0.33）。CTS患者发生AF和中风的可能性高于CTD患者，这表明无论其CHA₂DS₂-VASc评分（充血性心力衰竭、高血压、年龄、糖尿病、中风、血管疾病、年龄、性别分类）如何，前者均需使用抗凝剂治疗。由于CTS患者发绀和无症状AF的风险较低，他们通常在年龄较大时才出现症状。
