非持续性室性心动过速和程序性心室刺激在特发性扩张型心肌病患者危险分层中的作用。

Role of nonsustained ventricular tachycardia and programmed ventricular stimulation for risk stratification in patients with idiopathic dilated cardiomyopathy.

作者信息

Becker Rüdiger, Haass Markus, Ick Dirk, Krueger Carsten, Bauer Alexander, Senges-Becker Julia C, Voss Frederik, Hilbel Thomas, Niroomand Feraydoon, Katus Hugo A, Schoels Wolfgang

机构信息

University of Heidelberg, Department of Cardiology, Bergheimer Strasse 58, 69115 Heidelberg, Germany.

出版信息

Basic Res Cardiol. 2003 Jul;98(4):259-66. doi: 10.1007/s00395-003-0398-7.

DOI:10.1007/s00395-003-0398-7

PMID:12835955

Abstract

BACKGROUND

The prognostic role of asymptomatic nonsustained ventricular tachycardia (NSVT) and programmed ventricular stimulation (PVS) in patients with idiopathic dilated cardiomyopathy (IDC) remains controversial.

METHODS

The prognostic significance of ventricular arrhythmias, ejection fraction, NYHA class, atrial fibrillation and age for overall and sudden death mortality was prospectively studied in 157 patients with IDC (group 1) free of documented sustained ventricular arrhythmia and syncope. In 99 patients with asymptomatic NSVT (group 2), PVS with 2 - 3 extrastimuli was performed. Non-inducible patients were discharged without specific antiarrhythmic therapy, whereas those with inducible monomorphic ventricular tachycardia were implanted with an ICD.

RESULTS

In group 1, 48% of patients had NSVT. Overall and sudden death mortality were significantly higher in patients with NSVT (34.2 vs. 9.8%, p = 0.0001 and 15.8 vs. 3.7%, p = 0.0037; follow-up 22 +/- 14 months). Multivariate analysis revealed that NSVT independently predicts both overall and sudden death mortality (p = 0.0021 and.0221, respectively; adjusted for EF, NYHA class and age). In group 2, inducibility of sustained ventricular tachyarrhythmia was 7%, but sustained monomorphic VT occurred in 3% only. Two of 7 inducible patients experienced arrhythmic events during a follow-up of 25 +/- 21 months (positive predictive value 29%). Overall and sudden death mortality were 29% and 0% in the inducible group vs. 17 and 4% in the non-inducible group. Both overall and sudden death mortality were significantly lower in non-inducible patients from group 2 as compared to patients from group 1 with NSVT (p = 0.0043 and 0.0048), most likely due to a more common use of betablockers and a higher EF in the former group (p < 0.001, respectively).

CONCLUSIONS

In patients with IDC, NSVT independently predicts both overall and sudden death mortality. Due to a low inducibility rate and a poor positive predictive value, PVS seems inappropriate for further arrhythmia risk assessment. However, in spite of documented NSVT, the incidence of SCD in patients on optimized medical treatment including betablockers seems to be very low, questioning the need for specific arrhythmia risk stratification.

摘要

背景

无症状非持续性室性心动过速（NSVT）和程控心室刺激（PVS）在特发性扩张型心肌病（IDC）患者中的预后作用仍存在争议。

方法

前瞻性研究了157例无记录的持续性室性心律失常和晕厥的IDC患者（第1组）中心律失常、射血分数、纽约心脏协会（NYHA）分级、心房颤动和年龄对总体死亡率和猝死死亡率的预后意义。对99例无症状NSVT患者（第2组）进行了2 - 3次额外刺激的PVS。不能诱发的患者在未接受特定抗心律失常治疗的情况下出院，而可诱发单形性室性心动过速的患者植入了植入式心脏除颤器（ICD）。

结果

在第1组中，48%的患者有NSVT。NSVT患者的总体死亡率和猝死死亡率显著更高（34.2%对9.8%，p = 0.0001；15.8%对3.7%，p = 0.0037；随访22±14个月）。多因素分析显示，NSVT独立预测总体死亡率和猝死死亡率（分别为p = 0.0021和0.0221；根据射血分数、NYHA分级和年龄进行校正）。在第2组中，持续性室性心律失常的诱发率为7%，但仅3%发生持续性单形性室性心动过速。7例可诱发患者中有2例在25±21个月的随访期间发生心律失常事件（阳性预测值29%）。可诱发组的总体死亡率和猝死死亡率分别为29%和0%，而不可诱发组分别为17%和4%。与第1组有NSVT的患者相比，第2组不可诱发患者的总体死亡率和猝死死亡率均显著更低（p = 0.0043和0.0048），这很可能是由于前一组更常用β受体阻滞剂且射血分数更高（分别为p < 0.001）。