Sosnowski Maciej, Skrzypek-Wańha Janina, Korzeniowska Barbara, Tendera Michał
3rd Division of Cardiology, Silesian School of Medicine, Ziolowa St. 47, 40-635, Katowice, Poland.
Int J Cardiol. 2004 Mar;94(1):53-9. doi: 10.1016/j.ijcard.2003.04.006.
The purpose of this study was to determine the characteristics and predictive value of the variability of coupling interval of ventricular premature beats (VPBs) for cardiac mortality in patients with coronary artery disease (CAD).
Frequent VPBs have been linked to an increased risk for cardiac death in patients with coronary artery disease. It is unknown whether analysis of coupling interval of VPBs from ambulatory ECG recordings can be used for risk statification in these patients.
In 78 consecutive symptomatic patients with documented CAD who presented with frequent VPBs (>720/24 h), the analysis of VPBs' coupling interval (SDNV) was performed. Left ventricular function, ventricular arrhythmias and simple measures of heart rate variability were assessed. Mean follow-up was 702+/-329 days. Cardiac mortality was the primary end-point of the study.
During follow-up, 14 patients died-11 deaths were cardiac. Left ventricular ejection fraction (LVEF)<40%; no beta-blocker treatment and digoxin use were clinical variables showing a significant association with cardiac mortality. The presence of non-sustained ventricular tachycardia (nsVT), especially if more than five episodes were present; short mean sinus cycle (<750 ms) and SDNV were associated with cardiac deaths. Mean SDNV was 79+/-29 in victims and 63+/-29 in survivors (p<0.05). Univariate Cox regression analysis revealed that the presence of SDNV>80 ms carried a relative risk of 6.7 for cardiac mortality. The adjusted relative risk was 13.3 for nsVT and 4.4 for SDNV>80 ms. Among patients with nsVT, mortality rate was significantly higher with SDNV>80 ms (58%), compared to lower SDNV (14%, p<0.01). Sixty-four percent mortality rate was observed in patients with LVEF<40%, presence of nsVT and SDNV>80 ms, compared to 17% in similar patients with lower SDNV (p<0.05).
The analysis of coupling interval of ventricular premature beats form the same 24-h ECG recordings may complement the standard Holter analysis for risk stratification. This seems especially promising in the subgroups of patients at highest risk-those with LV systolic dysfunction, non-sustained VT or both.
本研究旨在确定冠心病（CAD）患者室性早搏（VPB）联律间期变异性的特征及其对心脏死亡的预测价值。
频发室性早搏与冠心病患者心脏死亡风险增加相关。动态心电图记录的室性早搏联律间期分析能否用于这些患者的风险分层尚不清楚。
对78例有症状且记录在案的冠心病患者进行分析，这些患者频发室性早搏（>720/24小时），分析室性早搏的联律间期（SDNV）。评估左心室功能、室性心律失常及心率变异性的简单指标。平均随访时间为702±329天。心脏死亡是本研究的主要终点。
随访期间，14例患者死亡，其中11例死于心脏疾病。左心室射血分数（LVEF）<40%；未使用β受体阻滞剂治疗及未使用地高辛是与心脏死亡显著相关的临床变量。非持续性室性心动过速（nsVT）的存在，尤其是发作超过5次时；平均窦性周期短（<750毫秒）及SDNV与心脏死亡相关。死亡患者的平均SDNV为79±29，存活患者为63±29（p<0.05）。单因素Cox回归分析显示，SDNV>80毫秒时心脏死亡的相对风险为6.7。nsVT的校正相对风险为13.3，SDNV>80毫秒时为4.4。在有nsVT的患者中，SDNV>80毫秒时的死亡率（58%）显著高于SDNV较低时（14%，p<0.01）。LVEF<40%、存在nsVT且SDNV>80毫秒的患者死亡率为64%，而SDNV较低的类似患者死亡率为17%（p<0.05）。
对同一24小时心电图记录的室性早搏联律间期进行分析，可能会补充标准动态心电图分析用于风险分层。这在高危亚组患者中似乎特别有前景，这些患者包括左心室收缩功能障碍、非持续性室性心动过速或两者皆有的患者。
