Duan Ming-Xuan, Zhao Xi, Li Shao-Lin, Tao Jun-Zhong, Li Bo-Yan, Meng Xin-Guo, Dai Dong-Pu, Lu Yan-Yu, Yue Zhen-Zhen, Du Yang, Rui Zi-Ao, Pang Shuo, Zhou Yuan-Hang, Miao Guang-Rui, Bai Lin-Peng, Zhang Qing-Yang, Zhao Xiao-Yan
Henan Key Laboratory of Hereditary Cardiovascular Diseases, Department of Cardiology, Cardiovascular Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Department of Cardiology, Chest Hospital of Henan Province, Zhengzhou, China.
Front Cardiovasc Med. 2022 Nov 3;9:995275. doi: 10.3389/fcvm.2022.995275. eCollection 2022.
Ventricular septal rupture (VSR) is a type of cardiac rupture, usually complicated by acute myocardial infarction (AMI), with a high mortality rate and often poor prognosis. The aim of our study was to investigate the factors influencing the long-term prognosis of patients with VSR from different aspects, comparing the evaluation performance of the Gensini score, Sequential Organ Failure Assessment (SOFA) score and European Heart Surgery Risk Assessment System II (EuroSCORE II) score systems.
This study retrospectively enrolled 188 patients with VSR between Dec 9, 2011 and Nov 21, 2021at the First Affiliated Hospital of Zhengzhou University. All patients were followed up until Jan 27, 2022 for clinical data, angiographic characteristics, echocardiogram outcomes, intraoperative, postoperative characteristics and major adverse cardiac events (MACEs) (30-day mortality, cardiac readmission). Cox proportional hazard regression analysis was used to explore the predictors of long-term mortality.
The median age of 188 VSR patients was 66.2 ± 9.1 years and 97 (51.6%) were males, and there were 103 (54.8%) patients in the medication group, 34 (18.1%) patients in the percutaneous transcatheter closure (TCC) group, and 51 (27.1%) patients in the surgical repair group. The average follow-up time was 857.4 days. The long-term mortality of the medically managed group, the percutaneous TCC group, and the surgical repair group was 94.2, 32.4, and 35.3%, respectively. Whether combined with cardiogenic shock (OR 0.023, 95% CI 0.001-0.054, = 0.019), NT-pro BNP level (OR 0.027, 95% CI 0.002-0.34, = 0.005), EuroSCORE II (OR 0.530, 95% CI 0.305-0.918, = 0.024) and therapy group (OR 3.518, 95% CI 1.079-11.463, = 0.037) were independently associated with long-term mortality in patients with VSR, and this seems to be independent of the therapy group. The mortality rate of surgical repair after 2 weeks of VSR was much lower than within 2 weeks ( = 0.025). The cut-off point of EuroSCORE II was determined to be 14, and there were statistically significant differences between the EuroSCORE II < 14 group and EuroSCORE II≥14 group (HR = 0.2596, 95%CI: 0.1800-0.3744, Logrank < 0.001).
Patients with AMI combined with VSR have a poor prognosis if not treated surgically, surgical repair after 2 weeks of VSR is a better time. In addition, EuroSCORE II can be used as a scoring system to assess the prognosis of patients with VSR.
室间隔破裂（VSR）是一种心脏破裂类型，通常并发急性心肌梗死（AMI），死亡率高且预后往往较差。本研究的目的是从不同方面探讨影响VSR患者长期预后的因素，比较Gensini评分、序贯器官衰竭评估（SOFA）评分和欧洲心脏手术风险评估系统II（EuroSCORE II）评分系统的评估性能。
本研究回顾性纳入了2011年12月9日至2021年11月21日在郑州大学第一附属医院的188例VSR患者。对所有患者进行随访至2022年1月27日，收集临床资料、血管造影特征、超声心动图结果、术中、术后特征及主要不良心脏事件（MACEs）（30天死亡率、心脏再入院）。采用Cox比例风险回归分析探讨长期死亡率的预测因素。
188例VSR患者的中位年龄为66.2±9.1岁，男性97例（51.6%），药物治疗组103例（54.8%），经皮导管封堵（TCC）组34例（18.1%），手术修复组51例（27.1%）。平均随访时间为857.4天。药物治疗组、经皮TCC组和手术修复组的长期死亡率分别为94.2%、32.4%和35.3%。是否合并心源性休克（OR 0.023，95%CI 0.001 - 0.054，P = 0.019）、NT - pro BNP水平（OR 0.027，95%CI 0.002 - 0.34，P = 0.005）、EuroSCORE II（OR 0.530，95%CI 0.305 - 0.918，P = 0.024）和治疗组（OR 3.518，95%CI 1.079 - 11.463，P = 0.037）与VSR患者的长期死亡率独立相关，且这似乎与治疗组无关。VSR发生2周后手术修复的死亡率远低于2周内（P = 0.025）。确定EuroSCORE II的截断点为14，EuroSCORE II < 14组和EuroSCORE II≥14组之间存在统计学显著差异（HR = 0.2596，95%CI：0.1800 - 0.3744，Logrank P < 0.001）。
AMI合并VSR患者若不进行手术治疗预后较差，VSR发生2周后进行手术修复是较好时机。此外，EuroSCORE II可作为评估VSR患者预后的评分系统。
