Zecchin Massimo, Di Lenarda Andrea, Gregori Dario, Moretti Michele, Driussi Mauro, Aleksova Aneta, Chersevani Dorita, Sabbadini Gastone, Sinagra Gianfranco
Cardiology Department, University of Trieste, Trieste, Italy.
Ital Heart J. 2005 Sep;6(9):721-7.
The identification of patients with idiopathic dilated cardiomyopathy (IDC) at higher risk of sudden death (SD) is still an unsolved issue, and the role of non-sustained ventricular tachycardia (NSVT) uncertain.
The effect of NSVT on total mortality, SD and life-threatening arrhythmias was evaluated in 554 patients with IDC on optimal medical treatment and at long-term follow-up (81 +/- 58 months).
At diagnosis, 240 patients (43%) had NSVT at Holter monitoring and 314 (57%) did not. During follow-up, 189 patients (5/100 patients-year) died or underwent heart transplantation; SD occurred in 53 patients (1.4/100 patients-year); SD + non-fatal ventricular arrhythmias occurred in 75 patients (2/100 patients-year). Patients with and without NSVT at diagnosis had the same 5-year transplant-free survival rate (76 vs 76%, p = NS) and a similar incidence of SD (10 vs 7%, p = NS). The length and rate of NSVT did not show any significant relationship with the outcome. Only heart failure symptoms (NYHA class III-IV) (hazard ratio [HR] 1.9, p = 0.015) and severe left ventricular impairment (left ventricular ejection fraction < or = 0.30 and left ventricular end-diastolic diameter > or = 70 mm) (HR 2.7, p < 0.0001) were independently associated with higher SD risk. At multivariate analysis the presence of frequent NSVT episodes (> or = 3 runs/day) was associated with an increased risk of total mortality (HR 1.68, p = 0.041) and of major ventricular arrhythmias (HR 2.11, p = 0.037), but only in the subgroup of patients with severe left ventricular impairment.
Patients with advanced heart failure symptoms, severe left ventricular dysfunction and dilation had a higher risk of SD independently of NSVT. The finding of more frequent NSVT was associated with an increased risk of all-cause mortality and of major ventricular arrhythmias in patients with severe left ventricular impairment.
识别特发性扩张型心肌病（IDC）患者中猝死（SD）风险较高者仍是一个未解决的问题，非持续性室性心动过速（NSVT）的作用尚不明确。
在554例接受最佳药物治疗且长期随访（81±58个月）的IDC患者中，评估NSVT对总死亡率、SD和危及生命的心律失常的影响。
诊断时，240例患者（43%）动态心电图监测发现有NSVT，314例（57%）未发现。随访期间，189例患者（5/100患者年）死亡或接受心脏移植；53例患者发生SD（1.4/100患者年）；75例患者发生SD + 非致命性室性心律失常（2/100患者年）。诊断时有和无NSVT的患者5年无移植生存率相同（76%对76%，p = 无显著性差异），SD发生率相似（10%对7%，p = 无显著性差异）。NSVT的持续时间和频率与结局无显著关系。仅心力衰竭症状（纽约心脏协会III-IV级）（风险比[HR] 1.9，p = 0.015）和严重左心室功能损害（左心室射血分数≤0.30且左心室舒张末期直径≥70 mm）（HR 2.7，p < 0.0001）与较高的SD风险独立相关。多因素分析显示，频繁NSVT发作（≥3阵次/天）与总死亡率增加（HR 1.68，p = 0.041）和主要室性心律失常风险增加（HR 2.11，p = 0.037）相关，但仅在严重左心室功能损害的患者亚组中如此。
有晚期心力衰竭症状、严重左心室功能障碍和扩张的患者，无论有无NSVT，SD风险均较高。在严重左心室功能损害的患者中，更频繁NSVT的发现与全因死亡率和主要室性心律失常风险增加相关。
