心脏瓣膜手术后新发房颤的时间趋势及相关危险因素
Temporal trend and associated risk factors for new-onset atrial fibrillation following cardiac valve surgery.
作者信息
Sood Abhinav, Toth Andrew, Abdallah Mouin, Gillinov Marc, Milind Desai, Allan Klein, Mohamed Kanj, Majdalany David
机构信息
Department of Cardiology, Mount Sinai Beth Israel, New York.
Division of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland.
出版信息
J Atr Fibrillation. 2020 Apr 30;12(6):2129. doi: 10.4022/jafib.2129. eCollection 2020 Apr-May.
AIMS
Post cardiac surgery atrial fibrillation (POAF) is common, with adverse implications. However, relatively little is known regarding the time varying nature of risk factors associated with POAF. We describe variation in POAF along with its associated risk factors.
METHODS
Medical records of adult patients undergoing cardiac valve surgery from 2003-13, without a history of pre-operative AF were analyzed retrospectively. POAF was adjudicated using inpatient and outpatient electrocardiograms (EKG). Risk of AF over time along with time-varying risk factors were estimated using multiphase non-linear logistic mixed effects model.
RESULTS
10,461 patients with 100,149 EKGs were analyzed [median follow-up 4 months (IQR 48 hours-2 years)]. AF prevalence changed with time since surgery and two distinct phases were identified. Prevalence peaked to 13% at 2 weeks (early phase) and 9% near 7 years post-operatively (late phase). Older age, greater severity of preoperative tricuspid valve (TV) regurgitation, mitral valve replacement and prior cardiac surgery were time-independent risk factors for POAF. TV repair was associated with a decreased risk of early phase POAF. Pre-operative blood urea nitrogen, peripheral vascular disease and hypertension were associated with a higher risk of late phase POAF.
CONCLUSIONS
POAF risk shows two distinct phases with an early peak and a late gradual rise, each associated with a different set of risk factors.
目的
心脏手术后房颤（POAF）很常见，且有不良影响。然而，对于与POAF相关的危险因素随时间变化的性质了解相对较少。我们描述了POAF及其相关危险因素的变化情况。
方法
回顾性分析2003年至2013年接受心脏瓣膜手术且无术前房颤病史的成年患者的病历。使用住院和门诊心电图（EKG）判定POAF。使用多阶段非线性逻辑混合效应模型估计随时间变化的房颤风险以及随时间变化的危险因素。
结果
分析了10461例患者的100149份EKG[中位随访时间4个月（四分位间距48小时 - 2年）]。房颤患病率随术后时间变化，确定了两个不同阶段。患病率在术后2周（早期）达到峰值13%，术后近7年（晚期）达到9%。年龄较大、术前三尖瓣（TV）反流严重程度较高、二尖瓣置换术和既往心脏手术是POAF的时间独立危险因素。TV修复与早期POAF风险降低相关。术前血尿素氮、外周血管疾病和高血压与晚期POAF风险较高相关。
结论
POAF风险呈现两个不同阶段，早期有一个峰值，晚期逐渐上升，每个阶段都与不同的危险因素组合相关。
Zotero 插件