Sajadieh Ahmad, Nielsen Olav Wendelboe, Rasmussen Verner, Hein Hans Ole, Frederiksen Benedikte Skott, Davanlou Maziar, Hansen Jørgen Fischer
Department of Cardiology, Copenhagen University Hospital of Bispebjerg and Rigshospitalet, Copenhagen, Denmark.
Am J Cardiol. 2006 May 1;97(9):1351-7. doi: 10.1016/j.amjcard.2005.11.067. Epub 2006 Mar 20.
Increased ventricular ectopic activity and even more complex arrhythmias are not uncommon in subjects without apparent heart disease. However, their prognostic significance has been controversial and not updated in recent years. The prevalence and prognostic significance of different ventricular arrhythmias were studied in a cohort of middle-aged and elderly subjects without apparent heart disease. Six hundred seventy-eight men and women aged 55 to 75 years without a history of heart disease or stroke were included. Baseline examinations included physical examinations, fasting laboratory testing, and 48-hour ambulatory electrocardiographic monitoring. All patients were followed for up to 5 years. Combined events were defined as all-cause mortality or acute myocardial infarction. A cardiovascular event was defined as cardiovascular death or acute myocardial infarction. In total, 84% had 0 to 10 ventricular premature complexes (VPCs)/hour, 8% had 11 to 30 VPCs/hour, and 8% had >30 VPCs/hour; 10.8% had >or=1 run of >or=3 VPCs. Frequent VPCs (>or=30/hour) was a significant predictor of combined (hazard ratio 2.47, 95% confidence interval 1.29 to 4.68, p = 0.006) and cardiovascular (hazard ratio 2.85, 95% confidence interval 1.16 to 7.0, p = 0.023) event rates, after adjustment for conventional risk factors. Runs of >or=4 VPCs/day or >or=2 doublets/day were also associated with a poor prognosis, but only in the presence of frequent VPCs. The detection of a single VPC on standard electrocardiography was a significant predictor of frequent VPCs and an independent predictor of events (hazard ratio 2.6, 95% confidence interval 1.02 to 6.66, p = 0.045). In conclusion, apparently healthy, middle-aged and elderly subjects with frequent VPCs (>or=30/hour) have a poor prognosis. According to current guidelines, strict risk-factor modification and primary prevention are justified in these high-risk subjects.
在没有明显心脏病的人群中，室性异位活动增加甚至更复杂的心律失常并不罕见。然而，它们的预后意义一直存在争议，且近年来未得到更新。在一组无明显心脏病的中老年人群中研究了不同室性心律失常的患病率和预后意义。纳入了678名年龄在55至75岁之间、无心脏病或中风病史的男性和女性。基线检查包括体格检查、空腹实验室检测和48小时动态心电图监测。所有患者随访长达5年。联合事件定义为全因死亡率或急性心肌梗死。心血管事件定义为心血管死亡或急性心肌梗死。总体而言，84%的人每小时有0至10次室性早搏（VPC），8%的人每小时有11至30次VPC，8%的人每小时有>30次VPC；10.8%的人有≥1阵≥3次的VPC。在调整传统危险因素后，频发VPC（≥30/小时）是联合事件（风险比2.47，95%置信区间1.29至4.68，p = 0.006）和心血管事件（风险比2.85，95%置信区间1.16至7.0，p = 0.023）发生率的显著预测因素。每天≥4次VPC发作或每天≥2次成对室性早搏也与预后不良相关，但仅在存在频发VPC的情况下。标准心电图上检测到单个VPC是频发VPC的显著预测因素和事件的独立预测因素（风险比2.6，95%置信区间1.02至6.66，p = 0.045）。总之，频发VPC（≥30/小时）的看似健康的中老年受试者预后不良。根据当前指南，在这些高危受试者中进行严格的危险因素修正和一级预防是合理的。
