基于家庭监测数据的植入型心律转复除颤器一级预防恰当治疗及全因死亡预测因素的研究  

Study on primary prevention and appropriate therapy of implantable cardioverter defibrillator and predictors of all-cause death based on home monitoring data

作　　者：赵爽[1] 陈柯萍[1] 华伟[1] 宿燕岗 刘欣[3] 梁兆光[4] 杨杰孚[5] 徐伟[6] 汪芳[7] 樊晓寒[1] 戴研[1] 刘志敏[1] 张澍[1] Zhao Shuang;Chen Keping;Hua Wei;Su Yangang;Liu Xin;Liang Zhaoguang;Yang Jiefu;Xu Wei;Wang Fang;Fan Xiaohan;Dai Yan;Liu Zhimin;Zhang Shu(Center of Arrhythmia,Fuwai Hospital,State Key Laboratory of Cardiovascular Disease,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences,Peking Union Medical College,Beijing 100037,China;Department of Cardiology,Zhongshan Hospital of Fudan University,Shanghai Institute of Cardiovascular Diseases,National Clinical Research Center for Interventional Medicine,Shanghai 200032,China;Department of Cardiology,Beijing Anzhen Hospital,Capital Medical University,Beijing 100011,China;Department of Cardiology,First Affiliated Hospital of Harbin Medical University,Harbin 150001,China;Department of Cardiology,Beijing Hospital,Beijing 100005,China;Department of Cardiology,Nanjing Drum Tower Hospital,The Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China;Department of Cardiology,Shanghai General Hospital,Shanghai 200080,China)

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心心血管疾病国家重点实验室阜外医院心律失常中心,100037 [2]复旦大学附属中山医院心内科上海市心血管病研究所国家放射与治疗临床医学研究中心,200032 [3]首都医科大学附属北京安贞医院心内科,100011 [4]哈尔滨医科大学附属第一医院心脏科,150001 [5]北京医院心脏科,100005 [6]南京大学医学院附属鼓楼医院心内科,210008 [7]上海市第一人民医院心脏科,200080

出　　处：《中华心律失常学杂志》2021年第2期97-101,共5页Chinese Journal of Cardiac Arrhythmias

摘　　要：目的基于植入型心律转复除颤器(ICD)家庭监测所传输的数据及患者的临床资料,探索ICD一级预防首次恰当治疗及患者全因死亡事件的预测因素。方法本研究回顾性分析了家庭监测功能在心血管植入型电子器械(CIED)的临床应用研究的部分数据。从2009年2月到2014年12月植入ICD(德国百多力公司)的79家医院的患者中根据入选和排除标准筛选出305例患者。将ICD植入后的第30~60天作为观察窗口期,计算30 d患者活动度均值(average of 30-day patient activity,APA)及30 d平均静息心率均值(average of 30-day mean rest heart rate,AMRHR)。主要终点事件为首次ICD恰当治疗恶性室性心律失常事件(VA),次要终点为全因死亡事件。结果随访(44.9±24.9)个月,共发生117例(38.4%,117/305)ICD首次恰当治疗事件及55例(18.0%,55/305)全因死亡事件。Cox多因素分析结果显示,AMRHR是除心功能(NYHA分级)及左心室射血分数(LVEF)外ICD首次发放恰当治疗VA的独立预测因素。年龄、左心室舒张末期内径(LVEDD)、心功能、APA是全因死亡的独立危险因素。通过ROC曲线对年龄、LVEDD、LVEF、APA、AMRHR对全因死亡的预测作用进行评估,结果显示APA对全因死亡的预测效果最好(AUC=0.703)。结论AMRHR和APA是ICD一级预防患者发生首次恰当治疗或全因死亡的较好的预测因素,研究结果可用于指导临床SCD一级预防高危患者的危险分层。Objective To investigate the predictive value of home monitoring data for appropriate therapy and all-cause mortality of implantable cardioverter defibrillator(ICD)for primary prevention.Methods This study retrospectively analyzed data from Study of Home Monitoring System Safety and Efficacy in Cardiac Implantable Electronic Device-implanted Patients.A total of 305 patients were included from 79 hospitals from Feb 2019 to Dec 2014.Data of patient activity and mean rest heart rate during the first 30-60 days recording by home monitoring system were collected and the average of 30-day patient activity(APA)and the average of 30-day mean rest heart rate(AMRHR)were calculated.The main endpoint was the first appropriate ICD therapy.The secondary endpoint was all-cause mortality.Results During a mean follow-up period of(44.9±24.9)months,117(38.4%,117/305)patients experienced the first appropriate ICD therapy and 55(18%,55/305)patients died.In univariate and multivariate Cox model,AMRHR was an independent predictive factor for the appropriate therapy in addition to NYHA class and left ventricular ejection fraction(LVEF).Age,left ventricular end-diastolic diameter(LVEDD),NYHA class and APA were independent risk factors for all-cause death.The predictive value of age,LVEDD,LVEF,APA,AMRHR for all-cause mortality was evaluated by ROC curve,and the results showed that APA had the best predictive value on all-cause death(AUC=0.703).Conclusion AMRHR and APA collected by home monitoring system have good predictive values for appropriate therapy or all-cause mortality in ICD patients for primary prevention.

关 键 词：除颤器 植入型 一级预防 家庭监测 室性心律失常 全因死亡 

分 类 号：R541.7[医药卫生—心血管疾病]