Faganello Giorgio, Barbati Giulia, Russo Giulia, Scagnetto Arjuna, Mazzone Carmine, Mottolese Biancamaria D 'Agata, Zaccari Michele, Sinagra Gianfranco, Lenarda Andrea Di, Cioffi Giovanni
Azienda Sanitaria Universitaria Integrata di Trieste, Via Slataper n°9, 34134, Trieste, Italy.
Dipartimento di Scienze Mediche e Chirurgiche e della Salute, Università degli Studi di Trieste, Trieste, Italy.
Pediatr Cardiol. 2020 Jun;41(5):1051-1057. doi: 10.1007/s00246-020-02356-5. Epub 2020 May 5.
Adult patients with simple congenital heart disease (sACHD) represent an expanding population vulnerable to atrial arrhythmias (AA). CHADS-VASc score estimates thromboembolic risk in non-valvular atrial fibrillation patients. We investigated the prognostic role of CHADS-VASc score in a non-selected sACHD population regardless of cardiac rhythm. Between November 2009 and June 2018, 427 sACHD patients (377 in sinus rhythm, 50 in AA) were consecutively referred to our ACHD service. Cardiovascular hospitalization and/or all-cause death were considered as composite primary end-point. Patients were divided into group A with CHADS-VASc score = 0 or 1 point, and group B with a score greater than 1 point. Group B included 197 patients (46%) who were older with larger prevalence of cardiovascular risk factors than group A. During a mean follow-up of 70 months (IQR 40-93), primary end-point occurred in 94 patients (22%): 72 (37%) in group B and 22 (10%, p < 0.001) in group A. Rate of death for all causes was also significantly higher in the group B than A (22% vs 2%, respectively, p < 0.001). Multivariable Cox regression analysis revealed that CHADS-VASc score was independently related to the primary end-point (HR 1.84 [1.22-2.77], p = 0.004) together with retrospective AA, stroke/TIA/peripheral thromboembolism and diabetes. Furthermore, CHADS-VASc score independently predicted primary end-point in the large subgroup of 377 patients with sinus rhythm (HR 2.79 [1.54-5.07], p = 0.01). In conclusion, CHADS-VASc score accurately stratifies sACHD patients with different risk for adverse clinical events in the long term regardless of cardiac rhythm.
患有单纯性先天性心脏病（sACHD）的成年患者数量不断增加，他们易患房性心律失常（AA）。CHADS-VASc评分用于评估非瓣膜性心房颤动患者的血栓栓塞风险。我们研究了CHADS-VASc评分在未经过筛选的sACHD人群中的预后作用，无论其心律如何。在2009年11月至2018年6月期间，427例sACHD患者（377例窦性心律，50例AA）连续被转诊至我们的成人先天性心脏病服务中心。心血管住院和/或全因死亡被视为复合主要终点。患者被分为A组（CHADS-VASc评分为0或1分）和B组（评分大于1分）。B组包括197例患者（46%），他们年龄较大，心血管危险因素的患病率高于A组。在平均70个月（四分位间距40 - 93）的随访期间，94例患者（22%）发生了主要终点事件：B组72例（37%），A组22例（10%，p < 0.001）。B组的全因死亡率也显著高于A组（分别为22%和2%，p < 0.001）。多变量Cox回归分析显示，CHADS-VASc评分与回顾性AA、中风/短暂性脑缺血发作/外周血栓栓塞以及糖尿病一起，与主要终点独立相关（风险比1.84 [1.22 - 2.77]，p = 0.004）。此外，CHADS-VASc评分在377例窦性心律患者的大子组中独立预测主要终点（风险比2.79 [1.54 - 5.07]，p = 0.01）。总之，无论心律如何，CHADS-VASc评分都能准确地将sACHD患者长期不良临床事件的不同风险进行分层。
