Abstract：
Mechanical prosthetic heart valves (MPHVs) are commonly used for valvular heart disease in patients with a long life expectancy. Few longitudinal data on the specific causes of hospitalization in patients with MPHV are available. We investigated the risk of all-cause hospitalization and mortality in patients with MPHV. We performed a prospective, observational, ongoing study including consecutive patients with MPHVs who were referred to the atherothrombosis outpatient clinic of the Policlinico Umberto I of Rome for the vitamin K antagonist management. Study end points were all-cause, cardiovascular hospitalization, and overall mortality. We included 305 patients with MPHV (38.4% women, median age 60.2 years). The site of MPHV was aortic in 53.5%, mitral in 29.5%, and mitroaortic in 17%. During a median follow-up of 57.3 months, 142 hospitalizations occurred (8.16 per 100 person-years). The most common causes of hospitalization were cardiovascular disease (3.62 per 100 person-years), infections, surgery, and bleeding. The predictors of cardiovascular hospitalization were atrial fibrillation (hazard ratio [HR] 1.75, 95% confidence interval [CI] 1.04 to 2.95, p = 0.035), previous stroke/transient ischemic attack (HR 2.96, 95% CI 1.59 to 5.48, p = 0.001), and peripheral artery disease (HR 2.42, 95% CI 1.09 to 5.36, p = 0.030). During a median follow-up of 97.2 months, 61 deaths occurred (2.43 per 100 person-years). Age was directly associated with the risk of death (HR 1.088, 95% CI 1.054 to 1.122, p <0.001), whereas the time in therapeutic range higher than the median was inversely associated (HR 0.436, 95% CI 0.242 to 0.786, p = 0.006). In conclusion, patients with MPHV had a high incidence of hospitalizations, especially cardiovascular-related. The incidence of death is high; however, it may be decreased by maintaining a good quality of anticoagulation.
摘要：
机械人工心脏瓣膜（MPHV）通常用于预期寿命长的瓣膜性心脏病患者。关于MPHV患者住院特定原因的纵向数据很少。我们调查了MPHV患者全因住院和死亡的风险。我们进行了一项前瞻性观察性持续研究，其中包括MPHV连续患者，这些患者参考罗马PoliclinicoUmbertoI的动脉粥样硬化血栓形成门诊诊所进行维生素K拮抗剂（VKA）管理。研究终点是全因，心血管住院和总死亡率。我们纳入了305例MPHV患者(38.4%的女性，中位年龄60.2岁)。53.5%的MPHV部位为主动脉，二尖瓣占29.5%，主动脉占17%。在57.3个月的中位随访中，142例住院（8.16/100人年）。住院最常见的原因是心血管疾病（每100人年3.62），感染,手术和出血。心血管住院的预测因素是心房颤动（危险比[HR]1.75，95%置信区间[95CI]1.04-2.95，p=0.035），既往卒中/短暂性脑缺血发作(HR2.96,95CI1.59-5.48,p=0.001)和外周动脉疾病(HR2.42,95CI1.09-5.36,p=0.030).在97.2个月的中位随访期间，61例死亡（每100人年2.43例）。年龄与死亡风险直接相关(HR1.088,95CI1.054-1.122,p<0.001),而高于中位数的治疗时间呈负相关(HR0.436,95CI0.242-0.786,p=0.006).总之,MPHV患者的住院率很高，尤其是与心血管有关的.死亡率很高，但它可能会减少通过保持良好的抗凝质量。
