Raphalen Jean-Herlé, Soumagnac Tal, Delord Marc, Bougouin Wulfran, Georges Jean-Louis, Paul Marine, Legriel Stéphane
Intensive Care Unit, Necker University Hospital, Assistance Publique-Hôpitaux de Paris, 149 rue de Sèvres, 75015 Paris, France.
Clinical Research Center, Versailles Hospital, 77 rue de Versailles, 78150 Le Chesnay, France.
Resusc Plus. 2023 Oct 12;16:100481. doi: 10.1016/j.resplu.2023.100481. eCollection 2023 Dec.
To assess outcomes and predictors of long-term myocardial dysfunction after cardiac arrest (CA) of cardiac origin.
We retrospectively included consecutive, single-center, prospective-registry patients who survived to hospital discharge for adult out-of-hospital and in-hospital CA of cardiac origin in 2005-2019. The primary objective was to collect the 1-year New York Heart Association Functional Class (NYHA-FC) and major adverse cardiovascular events (MACE).
Of 135 patients, 94 (72%) had their NYHA-FC determined after 1 year, including 75 (75/94, 80%) who were I, 17 (17/94, 18%) II, 2 (2/94, 2%) III, and none IV. The echocardiographic left ventricular ejection fraction was abnormal in 87/130 (67%) patients on day 1, 52/123 (42%) at hospital discharge, and 17/52 (33%) at 6 months. During the median follow-up of 796 [283-1975] days, 38/119 (32%) patients experienced a MACE. These events were predominantly related to acute heart failure (13/38) or ischemic cardiovascular events (16/38), with acute coronary syndrome being the most prevalent among them (8/16). Pre-CA cardiovascular disease was a risk factor for 1-year NYHA-FC > I ( = 0.01), absence of bystander cardiopulmonary resuscitation was significantly associated with NYHA-FC > I at 1 year.
Most patients had no heart-failure symptoms a year after adult out-of hospital or in-hospital CA of cardiac origin, and absence of bystander cardiopulmonary resuscitation was the only treatment component significantly associated with NYHA-FC > I at 1 year. Nearly a third experienced MACE and the most common types of MACE were ischemic cardiovascular events and acute heart failure. Early left ventricular dysfunction recovered within 6 months in half the patients with available values.
评估心源性心脏骤停（CA）后长期心肌功能障碍的结局及预测因素。
我们回顾性纳入了2005 - 2019年在单中心前瞻性登记研究中存活至出院的成年院外及院内心源性CA患者。主要目的是收集1年时的纽约心脏协会心功能分级（NYHA - FC）和主要不良心血管事件（MACE）。
135例患者中，94例（72%）在1年后进行了NYHA - FC评估，其中75例（75/94，80%）为I级，17例（17/94，18%）为II级，2例（2/94，2%）为III级，无IV级。130例患者中，87例（67%）在第1天超声心动图左心室射血分数异常，123例患者出院时52例（42%）异常，52例患者6个月时17例（33%）异常。在中位随访796 [283 - 1975]天期间，119例患者中有38例（32%）发生MACE。这些事件主要与急性心力衰竭（13/38）或缺血性心血管事件（16/38）相关，其中急性冠状动脉综合征最为常见（8/16）。心脏骤停前的心血管疾病是1年时NYHA - FC > I级的危险因素（P = 0.01），无旁观者心肺复苏与1年时NYHA - FC > I级显著相关。
大多数成年院外或院内心源性心脏骤停患者在1年后无心力衰竭症状，无旁观者心肺复苏是1年时与NYHA - FC > I级显著相关的唯一治疗因素。近三分之一的患者发生MACE，最常见的MACE类型是缺血性心血管事件和急性心力衰竭。在有可用数据的患者中，一半患者的早期左心室功能障碍在6个月内恢复。
