Niwano S, Wakisaka Y, Niwano H, Fukaya H, Kurokawa S, Kiryu M, Hatakeyama Y, Izumi T
Department of Cardio-angiology, Kitasato University School of Medicine, 1-15-1 Kitasato, Sagamihara City, Kanagawa, Japan 228-8555.
Heart. 2009 Aug;95(15):1230-7. doi: 10.1136/hrt.2008.159558. Epub 2009 May 7.
Recently, it has been reported that frequent premature ventricular contractions (PVCs) may be associated with causing heart failure in patients with left ventricular (LV) dysfunction. However, the prognostic significance of frequent PVCs in asymptomatic patients with a normal LV function is unclear.
Two hundred and thirty-nine consecutive patients presenting with frequent PVCs (>1000 beats/day) originating from the right or left ventricular outflow tract without any detectable heart disease were enrolled in the study. Structural heart disease was ruled out by echocardiography and cardiac magnetic resonance imaging, and Holter-ECG monitoring was repeated two or three times to evaluate the PVC prevalence at the initial evaluation. All patients were followed up for at least 4 years, and further observation was continued if possible.
During an observation period of 5.6 (1.7) years, no patients exhibited any serious cardiac events. Although there was no significant change in the mean LV ejection fraction (LVEF) and mean LV diastolic dimension (LVDd), there was a significant negative correlation between the PVC prevalence and DeltaLVEF (p<0.001) and positive correlation between the PVC prevalence and DeltaLVDd (p<0.001). When the development of LV dysfunction was defined as DeltaLVEF>-6%, 13 patients exhibited LV dysfunction. For the prediction of the development of LV dysfunction, PVC prevalence and LVEF at the initial evaluation were independent predicting factors (p<0.01).
Although the prognosis in patients with frequent PVCs was considered relatively benign, attention should be paid to the progression of the LV dysfunction during a long-term observation, especially in patients with a high PVC prevalence.
最近，有报道称频发室性早搏（PVC）可能与左心室（LV）功能不全患者发生心力衰竭有关。然而，频发PVC在无症状且左心室功能正常患者中的预后意义尚不清楚。
本研究纳入了239例连续出现频发PVC（>1000次/天）且起源于右或左心室流出道且无任何可检测到的心脏病的患者。通过超声心动图和心脏磁共振成像排除结构性心脏病，并重复进行两到三次动态心电图监测以评估初始评估时的PVC发生率。所有患者均随访至少4年，如有可能继续进一步观察。
在5.6（1.7）年的观察期内，无患者出现任何严重心脏事件。虽然左心室射血分数（LVEF）均值和左心室舒张内径（LVDd）均值无显著变化，但PVC发生率与LVEF变化值（DeltaLVEF）之间存在显著负相关（p<0.001），与LVDd变化值（DeltaLVDd）之间存在显著正相关（p<0.001）。当将左心室功能不全的发展定义为DeltaLVEF>-6%时，有13例患者出现左心室功能不全。对于左心室功能不全发展的预测，初始评估时的PVC发生率和LVEF是独立的预测因素（p<0.01）。
虽然频发PVC患者的预后被认为相对良好，但在长期观察期间应注意左心室功能不全的进展，尤其是PVC发生率高的患者。
