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左心室辅助装置患者的长期生存——一项TriNetX数据库分析

The Long-Term Survival of LVAD Patients-A TriNetX Database Analysis.

作者信息

Nair Nandini, Mahesh Balakrishnan, Du Dongping

机构信息

Department of Medicine, Division of Cardiology, Penn State Health/PSUCOM, 500 University Drive, Hershey, PA 17033, USA.

Department of Surgery, Division of Cardiothoracic Surgery, Penn State Health/PSUCOM, 500 University Drive, Hershey, PA 17033, USA.

出版信息

J Clin Med. 2024 Jul 13;13(14):4096. doi: 10.3390/jcm13144096.

Abstract

Donor shortage limits the utilization of heart transplantation, making it available for only a fraction of the patients on the transplant waiting list. Therefore, continuous-flow left ventricular assist devices (CF-LVADs) have evolved as a standard of care for end-stage heart failure. It is imperative therefore to investigate long-term survival in this population. This study assesses the impact of demographics, infections, comorbidities, types of cardiomyopathies, arrhythmias, and end-organ dysfunction on the long-term survival of LVAD recipients. The TriNetX database comprises de-identified patient information across healthcare organizations. The log-rank test assessed post-implant survival effects, while Cox regression was used in the univariate analysis to obtain the Hazard Ratio (HR). All analyses were conducted using the Python programming language and the lifelines library. This study identified CMV, hepatitis A exposure, atrial fibrillation, paroxysmal ventricular tachycardia, ischemic cardiomyopathy, renal dysfunction, diabetes, COPD, mitral valve disease, and essential hypertension as risk factors that impact long-term survival. Interestingly, hypokalemia seems to have a protective effect and gender does not affect survival significantly. This is the first report of a detailed long-term survival assessment of the LVAD population using a decoded database.

摘要

供体短缺限制了心脏移植的应用,使得只有一小部分移植等待名单上的患者能够接受心脏移植。因此,连续流左心室辅助装置(CF-LVADs)已发展成为终末期心力衰竭的一种标准治疗手段。因此,对这一人群的长期生存情况进行调查势在必行。本研究评估了人口统计学因素、感染、合并症、心肌病类型、心律失常和终末器官功能障碍对LVAD接受者长期生存的影响。TriNetX数据库包含了各医疗机构中经过身份识别处理的患者信息。对数秩检验评估植入后的生存效应,单因素分析中使用Cox回归来获得风险比(HR)。所有分析均使用Python编程语言和lifelines库进行。本研究确定巨细胞病毒、甲型肝炎暴露、心房颤动、阵发性室性心动过速、缺血性心肌病、肾功能不全、糖尿病、慢性阻塞性肺疾病、二尖瓣疾病和原发性高血压是影响长期生存的风险因素。有趣的是,低钾血症似乎具有保护作用,而性别对生存没有显著影响。这是第一份使用解码数据库对LVAD人群进行详细长期生存评估的报告。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/596a/11278369/fea87157ab99/jcm-13-04096-g001.jpg

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