室上性心动过速引发的心源性休克的一年期结局：FRENSHOCK多中心前瞻性注册研究分析
One-year outcomes in cardiogenic shock triggered by supraventricular tachycardia: an analysis of the FRENSHOCK multicenter prospective registry.
作者信息
Cherbi Miloud, Bonnefoy Eric, Lamblin Nicolas, Gerbaud Edouard, Bonello Laurent, Roubille François, Levy Bruno, Champion Sebastien, Lim Pascal, Schneider Francis, Elbaz Meyer, Khachab Hadi, Bourenne Jeremy, Seronde Marie-France, Schurtz Guillaume, Harbaoui Brahim, Vanzetto Gerald, Combaret Nicolas, Labbe Vincent, Marchandot Benjamin, Lattuca Benoit, Biendel-Picquet Caroline, Leurent Guillaume, Puymirat Etienne, Maury Philippe, Delmas Clément
机构信息
Intensive Cardiac Care Unit, Rangueil University Hospital, Toulouse, France.
Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR-1048, National Institute of Health and Medical Research (INSERM), Toulouse, France.
出版信息
Front Cardiovasc Med. 2023 Sep 5;10:1167738. doi: 10.3389/fcvm.2023.1167738. eCollection 2023.
BACKGROUND
Cardiogenic shock (CS) is the most severe form of heart failure (HF), resulting in high early and long-term mortality. Characteristics of CS secondary to supraventricular tachycardia (SVT) are poorly reported. Based on a large registry of unselected CS, we aimed to compare 1-year outcomes between SVT-triggered and non-SVT-triggered CS.
METHODS
FRENSHOCK is a French prospective registry including 772 CS patients from 49 centers. For each patient, the investigator could report 1-3 CS triggers from a pre-established list (ischemic, mechanical complications, ventricular/supraventricular arrhythmia, bradycardia, iatrogenesis, infection, non-compliance, and others). In this study, 1-year outcomes [rehospitalizations, mortality, heart transplantation (HTx), ventricular assist devices (VAD)] were analyzed and adjusted for independent predictive factors.
RESULTS
Among 769 CS patients included, 100 were SVT-triggered (13%), of which 65 had SVT as an exclusive trigger (8.5%). SVT-triggered CS patients exhibited a higher proportion of male individuals with a more frequent history of cardiomyopathy or chronic kidney disease and more profound CS (biventricular failure and multiorgan failure). At 1 year, there was no difference in all-cause mortality (43% vs. 45.3%, adjusted HR 0.9 (95% CI 0.59-1.39), = 0.64), need for HTx or VAD [10% vs. 10%, aOR 0.88 (0.41-1.88), = 0.74], or rehospitalizations [49.4% vs. 44.4%, aOR 1.24 (0.78-1.98), = 0.36]. Patients with SVT as an exclusive trigger presented more 1-year rehospitalizations [52.8% vs. 43.3%, aOR 3.74 (1.05-10.5), = 0.01].
CONCLUSION
SVT is a frequent trigger of CS alone or in association in more than 10% of miscellaneous CS cases. Although SVT-triggered CS patients were more comorbid with more pre-existing cardiomyopathies and HF incidences, they presented similar rates of mortality, HTx, and VAD at 1 year, arguing for a better overall prognosis.
CLINICAL TRIAL REGISTRATION
https://clinicaltrials.gov, identifier: NCT02703038.
背景
心源性休克（CS）是心力衰竭（HF）最严重的形式，导致早期和长期高死亡率。关于室上性心动过速（SVT）继发的心源性休克的特征报道较少。基于一个大型的未选择的心源性休克登记研究，我们旨在比较SVT诱发的心源性休克和非SVT诱发的心源性休克的1年结局。
方法
FRESHOCK是一项法国前瞻性登记研究，纳入了来自49个中心的772例心源性休克患者。对于每位患者，研究者可从预先设定的列表（缺血、机械并发症、室性/室上性心律失常、心动过缓、医源性、感染、不依从及其他）中报告1 - 3个心源性休克触发因素。在本研究中，分析了1年结局[再次住院、死亡率、心脏移植（HTx）、心室辅助装置（VAD）]，并对独立预测因素进行了校正。
结果
在纳入的769例心源性休克患者中，100例由SVT诱发（13%），其中65例以SVT作为唯一触发因素（8.5%）。SVT诱发的心源性休克患者中男性比例较高，有心肌病或慢性肾脏病病史者更常见，且心源性休克更严重（双心室衰竭和多器官衰竭）。1年时，全因死亡率（43%对45.3%，校正后HR 0.9（95%CI 0.59 - 1.39），P = 0.64）、心脏移植或心室辅助装置需求[10%对10%，校正后OR 0.88（0.41 - 1.88），P = 0.74]或再次住院率[49.4%对44.4%，校正后OR 1.24（0.78 - 1.98），P = 0.36]无差异。以SVT作为唯一触发因素的患者1年再次住院率更高[52.8%对43.3%，校正后OR 3.74（1.05 - 10.5），P = 0.01]。
结论
在超过10%的混合性心源性休克病例中，SVT单独或合并其他因素是心源性休克的常见触发因素。尽管SVT诱发的心源性休克患者合并更多的既往心肌病和心力衰竭发生率，但他们1年时的死亡率、心脏移植和心室辅助装置使用率相似，提示总体预后较好。
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