Personality and Mortality from Ischemic Heart Disease and Stroke

Background. The role of personality in the causation of circulatory diseases has been controversial. Methods. From June through August 1990, 41,442 residents of Miyagi Prefecture in northern Japan completed the Japanese version of the short-form Eysenck Personality Questionnaire-Revised and another questionnaire on various health habits. During 11 years of follow-up until March 31, 2001, we identified 90 deaths from ischemic heart disease (IHD) and 131 deaths from stroke. We used Cox regression to estimate the relative risk of IHD and stroke according to the three levels of four personality subscales (extraversion, neuroticism, psychoticism, and lie), with adjustment for sex, age, and other potentially confounding variables. Results. Multivariate relative risks of IHD for the highest verses the lowest level of personality subscales were 0.7 for extraversion, 1.1 for neuroticism, 1.3 for psychoticism, and 0.8 for lie. Multivariate relative risks of stroke for the highest verses the lowest level of personality subscales were 1.0 for extraversion, 0.9 for neuroticism, 1.2 for psychoticism, and 1.2 for lie. Conclusions. This prospective study does not support the hypothesis that personality is a risk factor for mortality from IHD and stroke.     

先天性心脏病介入治疗临床效果分析

目的观察介入治疗先天性心脏病(CHD)的临床疗效,总结治疗经验。方法选取2004—2012年我院收治的行介入治疗的CHD患者76例,其中继发孔型房间隔缺损(ASD)33例、室间隔缺损(VSD)18例、ASD合并VSD 1例、动脉导管未闭(PDA)21例、肺动脉瓣狭窄(PS)3例。ASD、VSD及PDA封堵术均采用国产蘑菇伞Amplatzer法。观察患者治疗效果。结果患者均无严重并发症发生,无死亡。封堵成功73例患者(除1例ASD患者,1例VSD患者和1例PDA患者)。随访1~24个月无残余分流及严重心脏事件。结论介入治疗CHD创伤小、安全、可靠、成功率高,值得进一步推广。     

Delivery Outcomes in Non-Tertiary Referral Centers for Women with Congenital Heart Disease

Background: Women with congenital heart disease (CHD) have increased risk for adverse events during pregnancy and delivery. Prior studies have assessed pregnancy and delivery outcomes at tertiary referral centers (TRC). The aim of our study was to assess pregnancy outcomes in women with CHD who deliver in a non-tertiary referral center (non-TRC). Methods: Clinical demographics were collected, including anatomic complexity, physiologic state and pre-pregnancy risk assessment. Patients were stratified by delivery location, either TRC or non-TRC. Maternal and neonatal complications of pregnancy were reported. Results: Women with CHD who delivered in a TRC had a higher pre-pregnancy risk when assessed by the Zahar and CARPREG-II scores, and had more patients fall into a higher WHO classification. There was no difference in rates of maternal cardiac complications between delivery locations (11%) and neonatal complications (20%) between deliveries at TRC and non-TRC. Conclusions: There were not increased maternal cardiac or neonatal complications when delivery occurred at a non-TRC. Neonatal complications remained high regardless of delivery location. This study suggests that proper risk assessment may help identify women who are candidates for safe delivery at non-TRC in women with CHD, and that neonatal resources should be considered when planning delivery location.     

Having a Partner and Having Children: Comparisons of Adults with Congenital Heart Disease and the General Population: A 15-Year Case-Control Study

Objectives: To examine whether patients with congenital heart disease (CHD) are less likely to have a partner or children than individuals from the general population. Methods: Longitudinal study with two assessments of the same patients (n = 244) from a hospital population and controls (n = 238) from the German Socio-Economic Panel (GSOEP) using parental education, patients age, and sex as matching criteria. The first patient study was conducted between 5/2003 and 6/2004, the second one between 5/2017 and 4/2019. Controls were drawn from GSOEP-surveys 2004 and 2018. CHD-severity was classified according to type of surgery: curative, reparative, or palliative. Living single was used as outcome measure, for offspring the outcome was having children or not. Results: Among women with CHD the rate of those living single was higher than among controls with the differences depending on disease complexity (curative: OR = 5.5; reparative: OR = 1.9; palliative: OR = 2.7). No statistically significant differences between patients and controls emerged in the male study population. With respect to children a marked difference emerged between women with CHD and controls. Among patients the odds of having children were lower than among controls (curative: OR = 0.3; reparative: OR = 0.3; palliative: OR = 0.2). The rate of patients with children with CHD (women: 5.6%; men: 4.9%) was higher than expected (1%) if compared with the general population. Conclusions: Using partnership and children as outcome criteria, patients with CHD are disadvantaged if compared to subjects from the general population. In female patients the social consequences of the disease turned out as more pervasive than in women.     

Hypertension and Heart Failure as Predictors of Mortality in an Adult Congenital Heart Defect Population

Early intervention to prevent premature mortality is vital for adults with congenital heart defects (CHD). Anatomic complexity and comorbid conditions are thought to contribute to CHD mortality. Since hypertension (HTN) and heart failure (HF) are the comorbid conditions among the most prevalent causes of death in the United States, and commonly accompany CHD, it is crucial to evaluate whether they are reliable predictors of mortality for adults with CHD (ACHD) independent of anatomic CHD complexity. A retrospective cross-sectional analysis of ACHD, aged 18–64, with concomitant HTN and/or HF and at least one health care encounter during 2008–2010 were assessed. Of 5,397 ACHD patients (18.3% HTN without HF, 4.4% HF without HTN, 8.3% with both), 3.0% died (n = 163) during the study period. Overall, the sample was 45.1% white, 61.4% female, and 29.0% had a complex CHD. Among those who died, 23.3% had HTN without HF, 17.2% had HF without HTN, and 42.3% had both. Crude analyses revealed that older age, male gender, black race, and having public health insurance were associated with increased mortality during the three-year study period compared to ACHD patients who were younger, female gender, white race, and covered by private health insurance. ACHD patients diagnosed with non-complex CHD lesions (i.e., shunts, valves, or shunts + valves) were at greater risk of dying compared to those with severe complex CHDs. When CHD type was assessed separately, those with valve lesions were more likely to die compared to those with complex CHD lesions. After adjustment for age, gender, race, insurance and CHD complexity, ACHD patients with HF, with or without HTN, were equally likely to die during the study period. However, ACHD patients with HF, without or without HTN, who had valve defects were more likely to die during the three-year study period compared to patients with complex CHDs.     

Lesion-based Patterns of Morbidity and Mortality in Hospitalized Adolescents with Congenital Heart Disease

Objective: The objective of this analysis is to describe the characteristics and morbidity during hospitalizations among adolescents with congenital heart disease (AdoCHD) from the Pediatric Health Information System (PHIS) database. Methods: The PHIS database was queried for all AdoCHD admissions aged 12–18 years (1/1/2004–12/31/2013). Major forms of CHD were identified by their International Classification of Diseases, ninth revision codes, further verified based on their secondary diagnosis and/or procedure codes. Patient characteristics, diagnoses, procedures and vital status were assessed. Results: In total, there were 4,267 adolescents admitted to 42 Children’s Hospitals, 58.3% were males, 24.6% single ventricle (SV) patients, 64.1% bi-ventricle (BV), and 11.3% could not be classified. They accounted for 8,512 hospitalizations (41,240 total hospital days), of which 31.6% were intensive care unit (ICU) stays. ICU stay was similar for the SV and BV patients with similar duration of mechanical ventilation between the two groups. Overall, the most common CHD among in-patients was tetralogy of Fallot (TOF, 36.4%). Larger proportion of the BV AdoCHD admissions were for elective surgical and electrophysiological procedures. There were 109 (2.5%) heart transplantations (1.3% SV vs. 0.6% BV) and 120 in-hospital deaths (2.8%) (1.1% SV vs. 1.3% BV). Hypoplastic left heart syndrome was the most common diagnosis in transplanted patients (46%) and those who died (28%); TOF (29%) was frequent in 91 (2.1%) patients who had cardiac arrests. Conclusions: Different hospitalization patterns exist for BV and SV AdoCHD. Recognizing this risk may encourage directing resources toward optimizing long-term care of CHD patients.     

复杂性先天性心脏病患儿的心电图与超声心动图比较分析

目的探讨复杂性先天性心脏病患儿的心电图与超声心动图检查结果的异同及原因。方法比较43例小儿复杂性先天性心脏病患儿的心电图与超声心动图检查,并比较两者心房、心室肥大及心脏位置的改变结果。结果复杂性先天性心脏病心电图均有明显异常的表现。其中30例与超声心动图检查结果基本吻合（69．8％）,13例与超声心动图检查结果不吻合（30.2％）,9例心电图表现为双心房,双心室肥大改变,超声心动图仅表现一侧心房或心室明显扩大,4例表现右位心样改变超声心动图则显示正常。结论复杂性先天性心脏病患儿的心电图常伴有P波极性和QRS电压和形态的变化,心电图图形同双心房或双心室肥大样改变相似,与一侧心房或心室的明显扩大有关,心电图图形同镜像右位心样改变,与心房反位伴房室连接不一致有关。     

甘肃省六地市先天性心脏病流行病学调查研究

目的 :对地处三大高原交汇地带的甘肃省黄河流域和河西走廊的儿童、青少年进行先天性心脏病 (先心病 )流行病学调查及遗传学研究。　　方法 :省先心病调查专题组调查了甘肃省三市 (兰州市、白银市、张掖市 )、三地区 (定西地区、酒泉地区、金昌地区 ) 2～ 19岁儿童、青少年共 115 5 35名 ,普查率为 96 .2 %。　　结果 :查出先心病患者 6 6 0例。总患病率为 5 .71‰。其中 2～ 5岁者患病率显著高于 6～ 19岁者 (P<0 .0 1) ;筛查出36个高发家系 ,家族患病率为 142 .40‰。　　结论 :河西走廊先心病发病率高于黄河流域。高原地区先心病患儿在学龄前形成重度肺动脉高压而夭折率偏高。     

Association of Hypertension and Diabetes with Ischemic Heart Disease and Stroke Mortality in India: The Million Death Study

Background:The cardiovascular outcomes of hypertension and diabetes in India have never been studied at the national level.Objectives:We conducted a nationally-representative proportional mortality study to measure the associations of hypertension and diabetes with premature mortality due to ischemic heart disease (IHD) and stroke among Indian adults.Methods:We determined causes of death by verbal autopsy from 2001–14 among 2.4 million households. We defined cases as those who died of the study outcomes and controls as those who died of injuries, respiratory causes, or cancer. We used multivariable logistic regression models to compute adjusted odds ratios (OR) measuring the association of hypertension and diabetes with IHD or stroke mortality, population-attributable fractions (PAF), and time trends.Results:The mean age at death was 55.6 (standard deviation 9.9) years for IHD, 58.2 (9.0) years for stroke, and 46.8 (injury) to 59.8 (respiratory) years for controls. There were more men among both the cases (IHD: 70.1%; stroke: 59.0%) and controls (injury: 76.6%; cancer: 55.4%; respiratory: 59.8%). Hypertension was associated with six- to eight-fold increases in the odds of IHD (OR 5.9, 99% CI 5.6–6.2) and stroke mortality (7.9, 7.4–8.5). Diabetes was associated with double the odds (1.9, 1.7–2.0) of IHD mortality and increased odds of stroke mortality (1.6, 1.4–1.7). Hypertension accounted for an increasing PAF of IHD mortality and decreasing PAF of stroke mortality. Diabetes was associated with relatively lower PAFs and variable time trends.Conclusions:Hypertension is associated with an unexpectedly high burden of cardiovascular mortality, and contributes to an increasing proportion of IHD deaths and a decreasing proportion of stroke deaths. Better management of hypertension and diabetes is urgently required to reduce premature cardiovascular mortality.     

叶酸代谢通路相关酶基因多态性与先天性心脏病的研究进展

先天性心脏病是最常见的婴幼儿先天性畸形,但目前病因不明,预防措施较少。近来研究认为,女性在怀孕前后3个月补充叶酸可以有效降低胎儿先天性心脏病的发病率。叶酸的转运和摄取、叶酸代谢和同型半胱氨酸的代谢均有重要的关键酶影响叶酸的代谢。为了揭示怀孕前后补充叶酸降低先天性心脏病发病率的潜在机制,本文对叶酸代谢通路相关酶基因多态性与先天性心脏病的关系进行综述。     

先天性心脏病合并气管狭窄的保守治疗策略

目的探讨先天性心脏病合并气管狭窄的保守治疗策略及可行性。方法回顾性分析阜外医院2009年1月至2011年12月间收治21例先心病合并气管狭窄的临床资料,对先心病并发上气道狭窄患儿术后采用早拔管策略;中下气道狭窄治疗上兼顾心肺功能调整及气道的管理。结果患儿年龄1～53月;体重4～14kg。术中插管困难发现18例,术后反复脱机困难发现3例。3例术后行纤维支气管镜及CT检查明确狭窄部位。除4例放弃心脏手术治疗外,合并上气道狭窄14例均治愈出院;中、下段狭窄3例中2例治愈出院,1例转外院置气管内支架。结论绝大多数先心病合并的节段性气道狭窄,实施早拔管的保守治疗策略是安全有效的;对合并长段狭窄的患儿在心、肺调整稳定后,仍反复脱机困难者应尽早考虑支架或外科治疗。     

Long-Term Outcome and Risk Factor Analysis of Surgical Pulmonary Valve Replacement in Congenital Heart Disease

Objectives: To establish long-term outcome of surgical pulmonary valve replacement (PVR) in congenital heart disease (CHD) and to identify risk factors for overall mortality, operative mortality, and repetitive PVR. Methods: This is a retrospective study of 375 surgical PVR in 293 patients who underwent surgical PVR for CHD between January 2000 and May 2020. We only included patients with index PVR with previous open-heart surgery regardless of the number of PVRs. The previous surgical history of patients who underwent PVR during the study period was also included. Patients who underwent the Rastelli operation, and those who underwent single PVR without previous open-heart surgery were excluded. Results: The median age of the patients at the time of surgical PVR was 14.9 years (Interquartile range, IQR, 11.0–22.0). The median follow-up duration was 10.5 years (IQR, 5.5–14.8 years). There were 3 patients with operative mortality (1.0%) and 15 patients with overall mortality (5.1%). The survival rate was 95.1% over 20 years follow-up period. Multivariate analysis demonstrated that more than 3 times of previous open-heart surgeries before surgical PVR, older age at the first operation, longer cardiopulmonary bypass (CPB) time and longer intensive care unit (ICU) stay were predictors for overall mortality. Patients who underwent surgical PVR after more than 3 times of previous open-heart surgeries had significantly higher mortality than those who underwent open-heart surgeries less than 3 times (P < 0.001). Age younger than 10 years, male, multiple valve problems and longer ICU stay were significant predictors for repetitive PVR by multivariate analysis. Conclusions: Though surgical PVR has excellent long-term outcome, it should be performed with caution for those who previously underwent multiple open-heart surgeries, especially if patient received more than 3 times of open-heart surgeries.     

Cardiac Surgery with Cardiopulmonary Bypass in Low-Weight or Preterm Neonates: A Retrospective Study Analyzing Early Outcome

Background: Most outcome studies in congenital cardiac surgery for “low weight” neonates include patients undergoing surgery without cardiopulmonary bypass (CPB). The primary objective of our study was to identify risk factors for in-hospital mortality in neonates weighing less than 3 Kg and undergoing surgery with CPB. In addition, we compared the effect of early surgery with CPB (before 37W-gestational age (GA)) for congenital heart disease to delayed surgery until a corrected GA of 37 weeks in an attempt to promote weight gain. Methods: Retrospective single-center study including all patients operated between 1997 and 2017. Uni- and multivariable analysis were used to analyze outcome. Results: 143 patients were included. The median weight was 2.7 Kg and 49 (34.3%) weighted <2.5 Kg. 80% of the patients were Risk stratification STAT categories ≥3. 114 patients (80%) were operated without delay (usual timing, median age 9 days), whereas 29 patients (20%) entered a delayed strategy (median age 30 days). In-hospital mortality was 21.7%. By multivariate analysis, dysmaturity, preoperative positive ventilation, post-operative ECMO requirement or resuscitation, and any residual lesion were predictors of in-hospital death. In-hospital mortality in the usual timing group and the delayed group were 21.1% and 24.1%, respectively (p = 0.71). In-hospital mortality for neonates operated prior to 37W-GA (n = 10) was 27.3%. Conclusions: Predictors of in-hospital mortality in neonates less 3 Kg requiring CPB surgery did not differ from those unveiled in other contemporary studies. Our data demonstrates that a strategy of delaying surgery in selected patients resulted in similar clinical outcome.