Casaleggio Aldo, Maestri Roberto, La Rovere Maria Teresa, Rossi Paolo, Pinna Gian Domenico
Biophysics Institute, CNR, Genova, Italy.
Europace. 2007 Jun;9(6):385-90. doi: 10.1093/europace/eum050. Epub 2007 Apr 16.
In patients with heart failure (HF), the association between sudden death and arrhythmic pattern at 24-h Holter monitoring [number of ventricular premature contractions per hour (VPCs/h) and presence of non-sustained ventricular tachycardia (NSVT)] has previously been investigated with conflicting results. Since both VPCs/h and NSVT disregard the time course of arrhythmic events, we developed a new index based on the short-term peak rate of ectopies and investigated its prognostic power in HF patients.
We studied 200 HF patients in sinus rhythm [age: [median (interquartile range)] 54 years [47-58], left ventricular ejection fraction (LVEF): 23% [19-28], New York Heart Association (NYHA) class II-III: 88%]. For each patient, the Holter recording was automatically scanned shifting a 30 beat window one beat at a time, and the maximum number of ectopic beats found in a window was named peak ectopy rate (PEAK_ER). The association between PEAK_ER and sudden death was assessed by Cox proportional hazards regression analysis. Survival analysis was also carried out adjusting for NYHA class, aetiology, LVEF, left ventricular end diastolic diameter, blood urea nitrogen, amiodarone, Digoxin, beta-blockers, NSVT, VPCs/h, and the standard deviation of all normal-to-normal beats. During a 5-year follow-up [31 (12-60) months], 23 patients died of sudden death. Out of the arrhythmic markers, PEAK_ER but not VPCs/h and NSVT was significantly associated with sudden death in univariable analysis (RR: 1.08, 95% CI: 1.02-1.14, P = 0.005) and after adjustment for covariates (RR: 1.09, 95% CI: 1.03-1.15, P = 0.004).
The investigation of the time course of arrhythmic events provides independent information in the identification of patients at increased risk of sudden death and may therefore be considered in the development of treatment strategies in HF patients.
在心力衰竭（HF）患者中，先前已对24小时动态心电图监测时的猝死与心律失常模式[每小时室性早搏次数（VPCs/h）和非持续性室性心动过速（NSVT）的存在]之间的关联进行了研究，结果相互矛盾。由于VPCs/h和NSVT均未考虑心律失常事件的时间进程，我们基于异位搏动的短期峰值率开发了一种新指标，并研究了其在HF患者中的预后能力。
我们研究了200例窦性心律的HF患者[年龄：[中位数（四分位间距）]54岁[47 - 58]，左心室射血分数（LVEF）：23%[19 - 28]，纽约心脏协会（NYHA）分级II - III级：88%]。对于每位患者，动态心电图记录通过每次移动一个30搏的窗口进行自动扫描，窗口中发现的异位搏动的最大数量被命名为峰值异位率（PEAK_ER）。通过Cox比例风险回归分析评估PEAK_ER与猝死之间的关联。还进行了生存分析，并对NYHA分级、病因、LVEF、左心室舒张末期内径、血尿素氮、胺碘酮、地高辛、β受体阻滞剂、NSVT、VPCs/h以及所有正常窦性搏动的标准差进行了校正。在5年的随访期[31（12 - 60）个月]内，23例患者死于猝死。在心律失常标志物中，单变量分析时PEAK_ER而非VPCs/h和NSVT与猝死显著相关（风险比：1.08，95%置信区间：1.02 - 1.14，P = 0.005），在对协变量进行校正后也是如此（风险比：1.09，95%置信区间：1.03 - 1.15，P = 0.004）。
对心律失常事件时间进程的研究为识别猝死风险增加的患者提供了独立信息，因此在制定HF患者的治疗策略时可予以考虑。
