Li Guan-Yi, Chen Yun-Yu, Chien Kuo-Liong, Lin Yenn-Jiang, Kuo Tzu-Ting, Chung Fa-Po
Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
Institute of Epidemiology and Preventive Medicine College of Public Health, National Taiwan University, Taipei, Taiwan.
Front Cardiovasc Med. 2021 Jul 15;8:676897. doi: 10.3389/fcvm.2021.676897. eCollection 2021.
The clinical significance and outcomes of ventricular tachyarrhythmias (VTa) in patients undergoing valve replacement have rarely been reported. This study aimed to investigate the incidence and outcome of VTa after surgical valve replacement. We conducted a population-based retrospective cohort study using data obtained from the Taiwan National Health Insurance Research Database. In total, 10,212 patients were selected after 1:1 propensity-score matching based on the type of prosthetic valve used (mechanical vs. bioprosthetic). Various outcomes during long-term follow-up were analyzed. After a median follow-up period of 59.6 months, the crude incidence rate of VTa after surgical valve replacement was 4.8/1,000 person-years, and the cumulative incidence of VTa persistently increased after surgery. Furthermore, the occurrences of VTa after valve replacement significantly increased the risk of cardiovascular (CV) death ( < 0.001, HR 1.67, 95% CI 1.41-1.96), stroke- ( < 0.001, HR 1.66, 95% CI 1.37-2.01), atrial fibrillation- ( < 0.001, HR 2.80, 95% CI 2.42-3.24), and congestive heart failure-related hospitalization ( < 0.001, HR 2.61, 95% CI 2.30-2.95). Among patients with VTa, all-cause mortality ( = 0.001, HR 0.49, 95% CI 0.32-0.75) and CV death ( = 0.047, HR 0.58, 95% CI 0.34-0.99) in those with implantable cardioverter-defibrillator (ICD) implantation were lower than those without. The crude incidence rate of VTa after surgical valve replacement was 4.8/1,000 person-years, and the cumulative incidence of VTa persistently increased during follow-up. The presence of VTa after surgical valve replacement increases hospitalization and CV death, while ICD implantation reduced the mortality rate in these patients.
接受瓣膜置换术患者室性快速心律失常（VTa）的临床意义及预后鲜有报道。本研究旨在调查外科瓣膜置换术后VTa的发生率及预后。我们利用从台湾国民健康保险研究数据库获得的数据进行了一项基于人群的回顾性队列研究。基于所使用的人工瓣膜类型（机械瓣膜与生物瓣膜）进行1:1倾向评分匹配后，共入选10212例患者。分析了长期随访期间的各种预后情况。中位随访期59.6个月后，外科瓣膜置换术后VTa的粗发病率为4.8/1000人年，且术后VTa的累积发病率持续上升。此外，瓣膜置换术后VTa的发生显著增加了心血管（CV）死亡风险（P<0.001，HR 1.67，95%CI 1.41 - 1.96）、中风风险（P<0.001，HR 1.66，95%CI 1.37 - 2.01）、心房颤动风险（P<0.001，HR 2.80，95%CI 2.42 - 3.24）以及充血性心力衰竭相关住院风险（P<0.001，HR 2.61，95%CI 2.30 - 2.95）。在发生VTa的患者中，植入植入式心律转复除颤器（ICD）者的全因死亡率（P = 0.001，HR 0.49，95%CI 0.32 - 0.75）和CV死亡率（P = 0.047，HR 0.58，95%CI 0.34 - 0.99）低于未植入者。外科瓣膜置换术后VTa的粗发病率为4.8/1000人年，随访期间VTa的累积发病率持续上升。外科瓣膜置换术后VTa的出现增加了住院率和CV死亡率，而ICD植入降低了这些患者的死亡率。
