植入型心电监测仪对60岁以上不明原因晕厥患者的诊断和干预价值研究  

Diagnostic and intervention value of implantable cardiac monitor in patients over 60 years of age with unexplained syncope

作　　者：王睿 张雁飞 张宏超 王佳 申淑慧 佟佳宾[1] 刘俊鹏[1] 吕游[1] 种甲[1] 王志蕾[4] 金鑫[4] 孙琳[4] 高旭 戴研 梁静[6] 李海涛[7] 邹彤[1] 杨杰孚[1] Wang Rui;Zhang Yanfei;Zhang Hongchao;Wang Jia;Shen Shuhui;Tong Jiabin;Liu Junpeng;Lyu You;Chong Jia;Wang Zhilei;Jin Xin;Sun Lin;Gao Xu;Dai Yan;Liang Jing;Li Haitao;Zou Tong;Yang Jiefu(Department of Cardiology,Beijing Hospital,Beijing 100730,China;Graduate School of Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China;Peking University Fifth School of Clinical Medicine,Beijing 100730,China;Department of Electrophysiology,Beijing Hospital,Beijing 100730,China;Center of Arrhythmia,Fuwai Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China;Department of Cardiology,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China;Department of Cardiology,Puren Hospital,Beijing 100062,China)

机构地区：[1]北京医院心血管内科、国家老年医学中心,北京100730 [2]北京协和医学院研究生院、中国医学科学院,北京100730 [3]北京大学医学部第五临床医学院,北京100730 [4]北京医院电生理室,北京100730 [5]中国医学科学院、北京协和医学院、阜外医院心律失常中心,北京100037 [6]首都医科大学附属北京安贞医院心血管内科,北京100029 [7]北京市普仁医院心血管内科,北京100062

出　　处：《中华心血管病杂志》2024年第7期784-790,共7页Chinese Journal of Cardiology

基　　金：北京市科技重大专项(D181100000218005)。

摘　　要：目的:探讨植入型心电监测仪在60岁以上不明原因晕厥患者中的诊疗价值。方法:该研究为多中心、前瞻性队列研究,纳入2018年6月至2021年4月于北京医院、阜外医院、北京安贞医院、普仁医院就诊的60岁以上不明原因晕厥患者。依据是否自愿接受植入型心电监测仪植入将入选患者分为植入组和传统随访组。终点事件为入组后再次发作晕厥,以及通过植入型心电监测仪记录的心律失常阳性事件判断或经传统随访检查后明确诊断心原性晕厥。使用Kaplan‐Meier生存分析比较两组间心原性晕厥累计诊断率差异。采用多因素Cox回归分析不明原因晕厥患者明确诊断心原性晕厥的独立预测因素。结果:共入选198例不明原因晕厥患者,年龄(72.9±8.25)岁,随访558.0(296.0,877.0)d,男性98例(49.5%)。植入组100例(50.5%),传统随访组98例(49.5%)。与传统随访组相比,植入组患者更高龄、更易发生合并症,基线心电图提示一度房室传导阻滞者占比更高,而体重指数更低( P均<0.05)。随访期间植入组共计58例(58.0%)患者的植入型心电监测仪记录到心律失常阳性事件。植入组心原性晕厥诊断率[42.0%(42/100)比4.1%(4/98), P<0.001]及治疗干预率[37.0%(37/100)比2.0%(2/98), P<0.001]均高于传统随访组。Kaplan‐Meier生存分析显示,与传统随访组相比较,植入组心原性晕厥累计诊断率更高,差异有统计学意义( HR=11.66,95% CI 6.49~20.98,log-rank P<0.001)。多因素Cox回归分析结果显示,植入型心电监测仪植入、既往心房颤动、糖尿病或基线心电图提示一度房室传导阻滞是不明原因晕厥患者明确诊断心原性晕厥的独立预测因素( P均<0.05)。 结论:植入型心电监测仪提高了不明原因晕厥患者的诊断率和干预率,显著增加不明原因晕厥的诊断效率。ObjectiveTo investigate the value of implantable cardiac monitor(ICM)in the diagnosis and treatment of patients over 60 years old with unexplained syncope.MethodsThis was a multi-center,prospective cohort study.Between June 2018 and April 2021,patients over the age of 60 with unexplained syncope at Beijing Hospital,Fuwai Hospital,Beijing Anzhen Hospital and Puren Hospital were enrolled.Patients were divided into 2 groups based on their decision to receive ICM implantation(implantation group and conventional follow-up group).The endpoint was the recurrence of syncope and cardiogenic syncope as determined by positive cardiac arrhythmia events recorded at the ICM or diagnosed during routine follow-up.Kaplan‐Meier survival analysis was used to compare the differences of cumulative diagnostic rate between the 2 groups.A multivariate Cox regression analysis was performed to determine independent predictors of diagnosis of cardiogenic syncope in patients with unexplained syncope.ResultsA total of 198 patients with unexplained syncope,aged(72.9±8.25)years,were followed for 558.0(296.0,877.0)d,including 98 males(49.5%).There were 100(50.5%)patients in the implantation group and 98(49.5%)in the conventional follow-up group.Compared with conventional follow-up group,patients in the implantation group were older,more likely to have comorbidities,had a higher proportion of first degree atrioventricular block indicated by baseline electrocardiogram,and had a lower body mass index(all P<0.05).During the follow-up period,positive cardiac arrhythmia events were recorded in 58(58.0%)patients in the ICM group.The diagnosis rate(42.0%(42/100)vs.4.1%(4/98),P<0.001)and the intervention rate(37.0%(37/100)vs.2.0%(2/98),P<0.001)of cardiogenic syncope in the implantation group were higher than those in the conventional follow-up group(all P<0.001).Kaplan-Meier survival analysis showed that the cumulative diagnostic rate of cardiogenic syncope was significantly higher in the implantation group than in the traditional follow-up group(HR=

关 键 词：晕厥 心原性晕厥 植入型心电监测仪 心电描记术 心律失常 病态窦房结综合征 房室传导阻滞 心房颤动 

分 类 号：R541.7[医药卫生—心血管疾病]