背景::我们试图评估围产期心肌病(PPCM)患者左心室血栓(LVT)的患病率和影响。
方法::我们在11年的时间内,对所有以PPCM为主要诊断的入院患者进行了回顾性队列研究。对所有危险因素和结果进行单变量分析,并对某些变量进行多变量逻辑回归分析,并表示为比值比(OR)和95%置信区间(CI)。<0.05的p值被认为是统计学上显著的。使用\'R\'工作室中的epDisplay进行统计分析。
结果::在2005-2014年的时间范围内,发现43,986例PPCM入院,其中包括43,534例无LVT和452例LVT患者。黑人种族与左心室血栓发生率较高有关,(p值<0.001)。在LVT组中更普遍的合并症是吸烟,药物滥用,妊娠高血压,糖尿病并发症,心脏瓣膜病,结缔组织疾病,凝血病,贫血和抑郁症。不良结果如充血性心力衰竭,LVT组心律失常和卒中发生率较高。相反,高加索种族,肥胖,无LVT的先兆子痫(p<0.005)较高。平均住院时间(9天vs5天,p<0.001),医院死亡率(3.32%vs1.41%,p=0.001)和平均住院费用(85,390美元对48,033美元)在LVT患者中更高。然而,关于多元逻辑回归,尽管LVT组的卒中较高(校正OR5.51,95%CI,2.2,13.81,5.05,p0.002),两组的住院死亡率无显著差异(校正OR1.17,95%CI,0.32,4.23,p=0.817).
结论::我们的研究表明,PPCM合并左心室血栓的患者卒中预后较差,住院时间和住院死亡率。黑人患者的患病率较高,复杂的糖尿病,外周血管疾病,瓣膜疾病,凝血病,吸烟,药物滥用,抑郁症和精神病需要特别注意这些高危人群的积极危险因素改变。
BACKGROUND: : We sought to assess the prevalence and impact of left ventricular thrombus (LVT) in patients with peripartum cardiomyopathy (PPCM).
METHODS: : We performed a retrospective cohort study of all admissions with PPCM as the primary diagnosis from the Nationwide Inpatient Sample database over a 11-year period. Univariate analysis of all risk factors and outcomes and multivariable logistic regression analysis of certain variables were performed and represented as odds ratio (OR) with 95% confidence interval (CI). A p value of < 0.05 was considered statistically significant. Statistical analysis was performed using epiDisplay in \'R\' studio.
RESULTS: : In the time frame spanning 2005 -2014, 43,986 admissions with PPCM were found which included 43,534 without LVT and 452 patients with LVT. Black race was associated with a higher incidence of LV thrombus, (p value <0.001). Comorbidities more prevalent in the LVT group were smoking, drug abuse, pregnancy induced hypertension, diabetes with complications, valvular heart disease, connective tissue disorders, coagulopathy, anemia and depression. Adverse outcomes such as congestive heart failure, arrhythmias and stroke were higher in LVT group. Conversely, Caucasian race, obesity, preeclampsia (p <0.005) were higher in those without LVT. Mean length of stay (9 vs 5 days, p <0.001), in hospital mortality (3.32% vs 1.41%, p = 0.001) and mean hospitalization charges ($85,390 vs $48,033) were higher in those with LVT. However, on multivariate logistic regression, although stroke was higher in the LVT group (adjusted OR 5.51, 95% CI, 2.2, 13.81, 5.05, p 0.002), in-hospital mortality was not significantly different between the two groups (adjusted OR 1.17, 95% CI,0.32, 4.23, p = 0.817).
CONCLUSIONS: : Our study showed that PPCM patients with LV thrombus had worse outcomes with respect to stroke, length of stay and in hospital mortality. Higher prevalence in patients with black race, complicated diabetes, peripheral vascular disease, valvular disease, coagulopathy, smoking, drug abuse, depression and psychoses calls for special attention to such high-risk groups for aggressive risk factor modification.