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Impact of Atrial Septal Defect Closure on Mortality in Older Patients

Congenital Heart Disease 2024年第1期19卷 93-105页

作者： Sipawath Khamplod yodying kaolawanich Khemajira Karaketklang Nithima Ratanasit Division of Cardiology Department of MedicineFaculty of Medicine Siriraj HospitalMahidol UniversityBangkokThailand Her Majesty Cardiac Center Faculty of Medicine Siriraj HospitalMahidol UniversityBangkokThailand Department of Medicine Faculty of Medicine Siriraj HospitalMahidol UniversityBangkokThailand

Background:Atrial septal defect(ASD)is a common form of adult congenital heart disease that can lead to long-term adverse outcomes if left untreated.Early closure of ASD has been associated with excellent outcomes and lower complication rates.However,there is limited evidence regarding the prognosis of ASD closure in older adults.This study aims to evaluate the mortality rates in older ASD patients with and without closure.Methods:A retrospective cohort study was conducted on patients aged 40 years or older with ASD between 2001 and 2017.Patients were followed up to assess all-cause mortality.Univariable and multivariable analyses were performed to identify the predictors of mortality.A p-value of<0.05 was considered statistically signiﬁcant.Results:The cohort consisted of 450 patients(mean age 56.6±10.4 years,77.3%female),with 66%aged between 40 and 60 years,and 34%over 60 years.Within the cohort,299 underwent ASD closure(201 with transcatheter and 98 with surgical closure).During the median follow-up duration of 7.9 years,51 patients died.The unadjusted cumulative 10-year rate of mortality was 3%in patients with ASD closure,and 28%in patients without ASD closure(log-rank p<0.001).Multivariable analysis revealed that age(hazard ratio[HR]1.04,95%conﬁdence interval[CI]1.006–1.06,p=0.01),NYHA class(HR 2.75,95%CI 1.63–4.62,p<0.001),blood urea nitrogen(BUN)(HR 1.07,95%CI 1.03–1.12,p<0.001),right ventricular systolic pressure(RVSP)(HR 1.07,95%CI 1.003–1.04,p=0.01),and lack of ASD closure(HR 15.12,95%CI 5.63–40.59,p<0.001)were independently associated with mortality.Conclusion:ASD closure demonstrated favorable outcomes in older patients.Age,NYHA class,BUN,RVSP,and lack of ASD closure were identiﬁed as independent factors linked to mortality in this population.

关键词： Atrial septal defect congenital heart disease defect closure long-term survival mortality

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Electrocardiographic predictors of cardiovascular events in patients at high cardiovascular risk: a multicenter study

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Journal of Geriatric Cardiology 2019年第8期16卷 630-638页

作者： Rungroj Krittayaphong Muenpetch Muenkaew Polakit Chiewvit Nithima Ratanasit yodying kaolawanich Arintaya Phrommintikul Division of Cardiology Department of MedicineFaculty of Medicine Siriraj HospitalMahidol UniversityBangkokThailand Division of Cardiology Department of MedicineFaculty of MedicineThammasat UniversityPathum ThaniThailand Department of Internal Medicine Faculty of MedicineChiang Mai UniversityChiang MaiThailand

Background There are limited data on the prevalence of electrocardiographic (ECG) abnormalities, and their value for predicting a major adverse cardiovascular event (MACE) in patients at high cardiovascular risk. This study aimed to determine the prevalence of ECG abnormalities in patients at high risk for cardiovascular events, and to identify ECG abnormalities that significantly predict MACE. Methods Patients aged ≥ 45 years with established atherosclerotic disease (EAD) were consecutively enrolled from the outpatient clinics of the six participating hospitals during April 2011 to March 2014. The following data were collected: demographic data, cardiovascular risk factors, history of cardiovascular event, physical examination, ECG and medications. ECG was analyzed using Minnesota Code criteria. MACE included cardiovascular death, non-fatal myocardial infarction, and hospitalization due to unstable angina or heart failure. Results A total of 2009 patients were included, 1048 patients (52.2%) had established EAD, and 961 patients (47.8%) had multiple risk factors (MRF). ECG abnormalities included atrial fibrillation (6.7%), premature ventricular contraction (5.4%), pathological Q-wave (Q/QS)(21.3%), T-wave inversion (20.0%), intraventricular ventricular conduction delay (IVCD)(7.3%), left ventricular hypertrophy (LVH)(12.2%), and AV block (12.5%). MACE occurred in 88 patients (4.4%). Independent predictors of MACE were chronic kidney disease, EAD, and the presence of atrial fibrillation, Q/QS, IVCD or LVH by ECG. Conclusions A high prevalence of ECG abnormalities was found. The prevalence of ECG abnormalities was high even among those with risk factors without documented cardiovascular disease.

关键词： Cardiovascular events Electrocardiographic High cardiovascular risk Predictors

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双频指数能改善麻醉用药及促进手术后恢复

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麻醉与镇痛 2009年第3期5卷 99-99页

作者： yodying Punjasawadwong Nutchanart Boonjeungmonkol Aram Phongchiewboon 赵薇(译)

背景：用临床指征来衡量麻醉的镇静效应并不可靠。用双频指数（BIS）来指导麻醉用药剂量比临床指征有一些优点。目的：我们研究的目的在于评估BIS是否能够减少麻醉用药剂量，缩短恢复时间，减少手术中知晓并降低费用。

关键词：麻醉用药双频指数手术后恢复临床指征镇静效应用药剂量恢复时间术中知晓

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