微伏极T波电交替筛选慢性心力衰竭患者预防性植入心脏复律除颤器的临床研究  

Microvolt T-wave alternans in screenning implantable cardioverter-defibrillator prophylaxis in patients with left ventricular dysfunction

作　　者：张进[1] 王礼琳[1] 丁立群[1] 张曦[1] 高晓龙[1] 高田[1] 姜玲[1] 范洁[1] 

机构地区：[1]云南省第一人民医院心内科,昆明650032

出　　处：《临床心血管病杂志》2014年第4期302-304,共3页Journal of Clinical Cardiology

基　　金：云南省应用基础研究计划项目(No:2008CD202)

摘　　要：目的:探讨微伏极T波电交替(MTWA)是否有助于选择预防性植入心脏复律除颤器(ICD)的慢性心力衰竭(心衰)患者,尤其是否有助于排除从ICD治疗中获益较少的低危患者。方法:入选左室射血分数(LVEF)≤35%并且无持续性室性心律失常的39例缺血性或非缺血性心肌病患者,所有患者用动态心电图时域分析法检测MTWA最大值。V3导联电压>47μV为阳性,电压≤47μV为阴性。MTWA测定后所有心衰患者植入ICD进行一级预防。术后1、3、6个月各随访1次,以后每6个月随访1次。主要终点为全因死亡或非致死性持续性室性心律失常。结果:有19例患者(48.7%)MTWA检查结果为阳性。在(20±4)个月的随访期内,MTWA阳性组发生13例终点事件(1例死亡和12例非致死性持续性室性心律失常),MTWA阴性组发生1例终点事件(1例非致死性持续性室性心律失常)。MTWA阳性预测价值为68.4%,阴性预测价值为95%。结论:对于LVEF≤35%且无持续性室性心律失常的缺血性或非缺血性心肌病患者,MTWA不仅有助于选择预防性植入心脏ICD的高危患者,而且有助于确定从预防性ICD植入中获益较少的低危患者。Objective= To evaluate the effect of microvolt T-wave alternans （MTWA） on screening patients with chronic heart failure for prophylactic implantable cardioverter defibrillator （ICD） treatment, especially for i- dentifying patients who are not likely to benefit. Method=A total of 39 patients were diagnosed with chronic heart failure caused by either ischemic or non-ischemic cardiomyopathy. The MTWA was analyzed using the modified moving average method by 24 h digital ambulatory electrocardiogram （GE Healthcare, Milwaukee, WI, USA）. MTWA magnitude more than 47 pV in lead V3 was defined as positive,while less than 47 uV was defined as nega- tive. All patients underwent ICD implantation and initial parameters were set up. All enrolled patients were fol- lowed up at 1, 3, 6 months, and then every 6 months. The primary endpoint was all-cause mortality or non-fatal sustained ventricular arrhythmias. Results=MTWA tests were positive in 19 （67 %） patients. During the follow-up period of （20 ± 4） months, there were 1 death and 12 non-fatal sustained ventricular arrhythmias in positive group, while 1 non-fatal sustained ventricular arrhythmias occurred in negative group. Positive and negative pre- dictive values of MTWA tests were 68.4 % and 95 %respectively. Coneluions Among patients with left ventricular ejection fraction （LVEF）≤35%, MTWA positive can identify a high-risk group, and MTWA negative can identi- fy a low-risk group that less likely to benefit from ICD prophylaxis.

关 键 词：心力衰竭 慢性 微伏极T波电交替 植入型心律复律除颤器 

分 类 号：R541.6[医药卫生—心血管疾病]