接受植入型心律转复除颤器二级预防的缺血性心肌病患者复发性室性快速心律失常的临床预测因素  

Clinical predictors of recurrent ventricular tachyarrhythmia a in patients with ischemic cardiomyopathy receiving implantable cardioverter-defibrillator secondary prevention

作　　者：高宇 贾文杰 柴慧 李润琴 GAO Yu;JIA Wenjie;CHAI Hui;LI Runqin(Department of Cardiovascular Medicine,Taiyuan Hospital,Peking University First Hospital,Taiyuan Central Hospital,Taiyuan 030000,China)

机构地区：[1]北京大学第一医院太原医院(太原市中心医院)心血管内科,030000

出　　处：《心肺血管病杂志》2024年第6期565-570,共6页Journal of Cardiovascular and Pulmonary Diseases

基　　金：太原市科技项目(202230)。

摘　　要：目的:分析接受植入型心律转复除颤器(implantable cardioverter defibrillator,ICD)二级预防的缺血性心肌病(ischemic cardiomyopathy,ICM)患者复发性室性快速心律失常(ventricular tachyarrhythmia,VTA)的临床预测因素。方法:回顾性纳入我院2013年1月至2018年12月期间,接受ICD二级预防的88例ICM幸存患者。收集患者基线资料,观察患者随访5年内复发性室性心动过速(ventricular tachycardia,VT)/心室颤动(ventricular fibrillation,VF)的发生情况。结果:单因素Cox回归分析结果显示,患者随访5年时发生复发性VT/VF的影响因素包括血管紧张素转换酶抑制剂/血管紧张素受体阻滞药的使用情况(HR=0.334,95%CI:0.159~0.705,P=0.004)以及左心室舒张末期容积(left ventricular end-diastolic volume,LVEDV)(HR=1.006,95%CI:1.002~1.011,P=0.006)。多因素Cox回归分析结果显示ACEI/ARB的使用情况以及LVEDV是影响患者随访5年时发生复发性VT/VF的独立临床因素(P<0.05)。LVEDV预测患者随访5年时发生复发性VT/VF的受试者工作特征曲线下面积为0.771(95%CI:0.672~0.869),在最佳截断值为163.5 mL。Kaplan-Meier生存曲线分析,LVEDV≤163.5 mL的患者随访1年(100.0%vs.76.7%,Log Rankχ^(2)=11.723,P=0.001)、3年(93.3%vs.58.1%,Log Rankχ^(2)=15.398,P<0.001)、5年(88.9%vs.46.5%,Log Rankχ^(2)=19.188,P<0.001)的无复发性VT/VF生存率明显更高。此外,57例患者在至少半年的医疗治疗后接受了随访超声心动图检查,LVEDV>163.5 mL的患者1年内复发性VTA发生率较高[LVEDV>163.5 mL vs.≤163.5 mL;37.9%(11/29)vs.7.1%(2/28);χ^(2)=7.670,P=0.006]。结论:LVEDV扩大可作为ICM患者随访5年内发生复发性VT/VF的独立预测因素。Objective:To analyze the clinical predictors of recurrent ventricular tachyarrhythmia(VTA)in patients with ischemic cardiomyopathy(ICM)receiving secondary prevention with implantable cardioverter-defibrillator(ICD).Methods:A total of 88 ICM patients who received ICD secondary prevention in our hospital from January 2013 to December 2018 were included retrospectively.The incidence of recurrent ventricular tachycardia(VT)/ventricular fibrillation(VF)during 5 years of follow-up was observed.Results:Univariate Cox regression analysis showed that the influencing factors for recurrent VT/VF at 5 years of follow-up included the use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers(B=-1.079,HR=0.334,95%CI:0.159-0.705,P=0.004)and left ventricular end-diastolic volume(LVEDV)(B=0.006,HR=1.006,95%CI:1.002-1.011,P=0.006).Multivariate Cox regression analysis showed that the use of ACEI/ARB and LVEDV were independent clinical factors affecting the occurrence of recurrent VT/VF at 5 years of follow-up(P<0.05).LVEDV predicted that the area under the receiver operating characteristic curve for recurrent VT/VF at 5 years of follow-up was 0.771(95%CI:0.672-0.869),and the optimal cut-off value was 163.5 mL.Kaplan-Meier survival curve analysis showed that patients with LVEDV≤163.5 mL were followed up for 1 year(100.0%vs.76.7%,Log Rankχ^(2)=11.723,P=0.001)and 3 years(93.3%vs.58.1%,Log Rankχ^(2)=15.398,P<0.001)and 5-year(88.9%vs.46.5%,Log Rankχ^(2)=19.188,P<0.001)recurrence-free VT/VF survival was significantly higher.In addition,57 patients underwent follow-up echocardiography after at least six months of medical treatment.Patients with LVEDV>163.5 mL had a higher incidence of recurrent VTA within one year[LVEDV>163.5 mL vs.≤163.5 mL;37.9%(11/29)vs.7.1%(2/28);χ^(2)=7.670,P=0.006].Conclusions:LVEDV enlargement can be used as an independent predictor of recurrent VT/VF in ICM patients during 5 years of follow-up.

关 键 词：植入型心律转复除颤器 二级预防 缺血性心肌病 复发性室性快速性心律失常 左心室舒张末期容积 

分 类 号：R54[医药卫生—心血管疾病]