肺血管阻力对左心衰竭患者植入埋藏式心脏复律除颤器后室性心律失常事件的预测价值  

Prognostic Value of Pulmonary Vascular Resistance for Ventricular Arrhythmia Events in Implantable Cardioverter Defibrillator Recipients With Left Sided Heart Failure

作　　者：陈灏璟 张娟[2] 潘昌[2] 胡作英[2] 张航[2] CHEN Hao-jing, ZHANG Juan, PAN Chang, HU Zuo-ying, ZHANG Hang(Department of Geriatric, The Affiliated Nanjing Hospital of Nanjing Medical University （Nanjing First Hospital）, Nanjing （210006）, Jiangsu, China)

机构地区：[1]南京医科大学附属南京医院(南京市第一医院)老年科,江苏省南京市210006 [2]南京医科大学附属南京医院(南京市第一医院)心血管内科,江苏省南京市210006

出　　处：《中国循环杂志》2018年第7期694-699,共6页Chinese Circulation Journal

摘　　要：目的:探讨肺血管阻力(PVR)对左心衰竭患者植入埋藏式心脏复律除颤器(ICD)后室性心动过速(室速)以及因心力衰竭再住院或全因死亡的复合终点事件的预测价值。方法:入选2010-01至2016-12期间在南京市第一医院因左心衰竭植入ICD或心脏再同步化治疗除颤器(CRT-D)进行一级或二级预防的122例患者。所有患者植入装置前接受超声心动图检查,记录肺动脉收缩压(PASP)、平均肺动脉圧(m PAP)和PVR。每6个月随访一次,记录程控数据及终点事件,主要终点为出现室速并接受ICD恰当治疗(包括抗心动过速治疗及电击治疗),次要终点为因心力衰竭再住院或全因死亡的复合终点。结果:平均随访4.2年,36例(29.5%)患者共记录到121次ICD恰当治疗,其中32例(26.3%)接受抗心动过速治疗72次,16例(13.1%)接受电击治疗39次。多因素Cox回归分析表明,PVR是左心衰竭患者植入ICD后出现室速并接受ICD恰当治疗的独立危险因素(HR=1.630,95%CI:1.170~2.010,P<0.01)。31例患者发生次要终点事件,其中29例(23.7%)因心力衰竭再住院共31次,18例(14.7%)死亡。多因素Cox回归分析显示,PVR是心力衰竭患者植入ICD后因心力衰竭再住院或死亡复合事件的独立预测因素(HR=2.030,95%CI:1.210~3.120,P<0.01)。结论:PVR是左心衰竭患者植入ICD后出现室速并接受ICD恰当治疗以及因心力衰竭再住院或全因死亡复合终点事件的独立预测因素。Objectives： The purpose of this study was to investigate the predicting value of pulmonary vascular resistance（PVR）on the occurrence of ventricular tachycardia（VT） and re-hospitalization due to heart failure or all-cause mortality in implantable cardioverter defibrillator（ICD） recipients with left sided heart failure. Methods： Present study included 122 patients with left sided heart failure implanted with ICD or cardiac resynchronization therapy-defibrillator（CRT-D） for the primary prevention and secondary prevention of sudden cardiac death. Pulmonary artery systolic pressure（PASP）, mean pulmonary artery pressure（m PAP） and pulmonary vascular resistance（PVR） were measured by echocardiography in all patients before implantation. Patients were followed up at 6-months interval, program-controlled data and end-point events were analyzed. The primary end-point was defined as the appropriate ICD therapy（ATP or Shock） in response to ventricular tachycardia or ventricular fibrillation, the secondary composite end-point was the re-hospitalization due to heart failure or all-cause mortality. Results： During the 4.2 years follow-up, 121 episodes of ventricular tachycardia or ventricular fibrillation were terminated by appropriate ICD therapy in 36 patients（29.5%）. Appropriate ICD therapy consisted of 72 episodes of ATPin 32 patients（26.3%） and 39 ICD shocks in 16 patients（13.1%）. Multivariable Cox regression analysis demonstrated that PVR was an independent predictor for appropriate ICD therapy in patients with left sided heart failure（HR：1.63, 95%CI：1.17-2.01, P 0.01）. The secondary composite end-point was documented in 31 patients. In total, 31 re-hospitalizations due to heart failure were documented in 29（23.7%） patients, and 18（14.7%） patients died. Multivariable Cox regression analysis demonstrated that PVR was the only independent predictor of the secondary composite end-point in patients with left sided heart failure（HR：2.03, 95% CI：1.21-3.12, P

关 键 词：慢性心力衰竭 心脏复律除颤器 肺血管阻力 室性心律失常 

分 类 号：R54[医药卫生—心血管疾病]