微伏级T波电交替对心脏再同步治疗患者远期快速性室性心律失常发生的预测价值  

Predictive value of microvolt T-wave alternation for long-term ventricular tachyarrhythmia in patients with cardiac resynchronization therapy

作　　者：李东程 唐园园[2] 王垚[1] 钱智勇[1] 姜泽宇 薛思源 侯小锋[1] 邹建刚[1] Li Dongcheng;Tang Yuanyuan;Wang Yao;Qian Zhiyong;Jiang Zeyu;Xue Siyuan;Hou Xiaofeng;Zou Jiangang(Department of Cardiology,The First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China;Department of General Internal Medicine,Jiangsu Provincial Hospital of Traditional Chinese Medicine,Nanjing University of Traditional Chinese Medicine,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院心血管内科,210029 [2]南京中医药大学附属江苏省中医院普内科,210029

出　　处：《中华心律失常学杂志》2021年第3期244-248,共5页Chinese Journal of Cardiac Arrhythmias

基　　金：江苏省科技厅临床前沿技术(BE2016764)。

摘　　要：目的本研究旨在探究微伏级T波电交替(MTWA)对心脏再同步治疗(CRT)患者远期快速性室性心律失常(VTA)发生的预测价值。方法本研究为诊断性试验研究。选取自2010年5月至2015年1月于南京医科大学第一附属医院心血管内科成功植入心脏再同步治疗起搏器(CRT-P)或心脏再同步治疗除颤器(CRT-D)的慢性心力衰竭(CHF)患者45例,年龄(59.5±12.3)岁,男33例(73.3%,33/45)。所有患者均于术前和术后6个月接受超声心动图和心电图检查,采用活动平板时域法于术后1周内和6个月时在双心室(BiV)110次/min起搏频率下测定MTWA。VTA事件均采自程控仪调取的CRT-P或CRT-D记录的持续性室性心动过速(室速)、心室颤动(室颤),包括抗心动过速起搏(ATP)、电复律(CV)或电除颤治疗的事件,随访(55.3±34.2)个月。按照有无发生VTA事件将患者分为VTA组(A组)和无VTA组(B组)。结果①CRT对CHF患者左心室射血分数(LVEF)及MTWA的影响:a.两组患者术后6个月LVEF较基线均明显增高[A组:(36.8%±9.8%)对(30.0%±7.1%),P=0.004;B组:(44.1%±12.7%)对(31.5%±7.6%),P<0.001];b.两组患者术后6个月MTWA(MTWA2)较基线MTWA(MTWA1)均有下降,但差异无统计学意义。②MTWA对CRT术后远期VTA发生的预测价值:a.基线和术后6个月A组患者的MTWA值明显大于B组[MTWA1:(26.6±21.0)μV对(11.4±6.8)μV,P=0.002;MTWA2:(19.0±15.4)μV对(9.8±10.0)μV,P=0.02]。b.以22μV和13μV分别作为MTWA1和MTWA2的分界点,将患者分为MTWA阳性组与阴性组,基线与术后6个月MTWA阳性组患者VTA的发生率均明显大于MTWA阴性组(基线,P=0.002;术后6个月,P=0.012)。MTWA1以22μV为最佳分界点,预测VTA事件的敏感性为47.6%,特异性为95.8%;MTWA2以13μV为最佳分界点,预测VTA事件的敏感性为61.9%,特异性75.0%。c.用Log rank法对VTA发生时间分布的差异进行检验:MTWA1阳性组、MTWA2阳性组发生VTA的时间比同组阴性组发生时间明显缩短。d.采用二分类Logistic回归分析�Objective To explore the predictive value of microvolt T-wave alternation(MTWA)for long-term ventricular tachyarrhythmia(VTA)after cardiac resynchronization therapy(CRT).Methods This research was a diagnostic test research.This study enrolled 45 patients with chronic heart failure(CHF)who were successfully implanted with cardiac resynchronization therapy pacing(CRT-P)or cardiac resynchronization therapy defibrillator(CRT-D)from May 2010 to January 2015 in department of cardiology in the First Affiliated Hospital of Nanjing Medical University[mean age:(59.5±12.3)years old],including 33 males(73.3%,33/45).All patients underwent echocardiography and electrocardiogram preoperatively and 6 months postoperatively.MTWA values​​were measured at a biventricular(BiV)pacing rate of 110 beats per minute within one week and six months after device implantation using modified moving average analyses.VTA events,including sustained ventricular tachycardia,ventricular fibrillation,anti-tachycardia pacing(ATP)or cardioversion(CV)or shock therapy were collected from the device.The average follow-up time was(55.3±34.2)months.According to the presence or absence of VTA events,all patients were divided into VTA group(Group A)and non-VTA group(Group B).Results①The effect of CRT on left ventricular ejection fraction(LVEF)and MTWA in CHF patients:a.The LVEF​​of two groups were significantly improved at six-month follow-up than baseline[Group A:(36.8%±9.8%)vs.(30.0%±7.1%),P=0.004;Group B:(44.1%±12.7%)vs.(31.5%±7.6%),P<0.001].b.The MTWA value at six-month(MTWA2)decreased compared to the baseline MTWA(MTWA1)in two groups,but there was no statistical difference.②The predictive value of MTWA for long-term VTA:a.The MTWA of Group A at baseline and six months was significantly higher than that of Group B[MTWA1:(26.6±21.0)μV vs.(11.4±6.8)μV,P=0.002;MTWA2:(19.0±15.4)μV vs.(9.8±10.0)μV,P=0.02).b.Using 22μV and 13μV as the cut-off point for MTWA1 and MTWA2 respectively,all patients were divided into MTWA positive group a

关 键 词：心脏再同步治疗 微伏级T波电交替 快速性室性心律失常 远期随访 慢性心力衰竭 

分 类 号：R541.7[医药卫生—心血管疾病]