运动诱发的室性心律失常与肥厚型心肌病患者心源性猝死的风险。

Exercise-induced ventricular arrhythmias and risk of sudden cardiac death in patients with hypertrophic cardiomyopathy.

机构信息

The Heart Hospital, University College London, 16-18 Westmoreland Street, London W1G 8PH, UK.

出版信息

Eur Heart J. 2009 Nov;30(21):2599-605. doi: 10.1093/eurheartj/ehp327. Epub 2009 Aug 17.

DOI:10.1093/eurheartj/ehp327

PMID:19689975

Abstract

BACKGROUND

Non-sustained ventricular tachycardia (NSVT) during ambulatory electrocardiographic monitoring (typically occurring at rest or during sleep) is associated with an increased risk of sudden cardiac death in patients with hypertrophic cardiomyopathy. The prevalence and prognostic significance of ventricular arrhythmias during exercise is unknown.

METHODS AND RESULTS

This was a cohort study, with prospective data collection. We studied 1380 patients, referred to a cardiomyopathy clinic in London, UK [mean age 42 years (SD 15); 62% male; mean follow-up 54 (SD 49) months]. Patients underwent two-dimensional and Doppler echocardiography, upright exercise testing, and Holter monitoring. Twenty-seven patients [mean age 40 (SD 14) years (18-64); 22 (81.5%) male] had NSVT (24) or ventricular fibrillation (VF) (3) during exercise. During exercise, 13 (54.2%) had more than one run of NSVT (maximum 5) with a mean heart rate of 221 (SD 48) b.p.m. Patients with exercise NSVT/VF had more severe hypertrophy (22.6 vs. 19.5 mm, P = 0.009) and larger left atria (47.3 vs. 43.7 mm, P = 0.03). Male gender was significantly associated with exercise NSVT/VF [22 (81.5%) vs. 832 (61.5%), P = 0.03]. Eight (29.6%) of the exercise NSVT/VF patients died or had a cardiac event (SD/ICD discharge/transplant) compared with 150 (11.1%) patients without exercise NSVT/VF, P = 0.008. Patients with NSVT/VF had a 3.73-fold increase in risk of SD/ICD discharge (HR 95% CI: 1.61-8.63, P = 0.002). Exercise NSVT alone was associated with a 2.82-fold increased risk (HR 95% CI: 1.02-7.75, P = 0.049). In multivariable analysis with other risk markers, exercise NSVT/VF (but not NSVT alone) was independently associated with an increased risk of SD/ICD [HR 3.14 (95% CI: 1.29-7.61, P = 0.01)].

CONCLUSION

Ventricular arrhythmia during symptom limited exercise is rare in patients with hypertrophic cardiomyopathy, but is associated with an increased risk of sudden cardiac death.

摘要

背景

在动态心电图监测（通常在休息或睡眠时发生）期间出现非持续性室性心动过速（NSVT）与肥厚型心肌病患者心脏性猝死风险增加相关。运动期间室性心律失常的发生率和预后意义尚不清楚。

方法和结果

这是一项前瞻性数据收集的队列研究。我们研究了 1380 名患者，他们被转诊到英国伦敦的心肌病诊所[平均年龄 42 岁（15 岁标准差）；62%为男性；平均随访 54（49 岁标准差）个月]。患者接受二维和多普勒超声心动图、直立运动试验和动态心电图监测。27 名患者[平均年龄 40（14 岁标准差）岁（18-64 岁）；22 名（81.5%）为男性]在运动时出现 NSVT（24 例）或心室颤动（VF）（3 例）。运动时，13 名（54.2%）患者出现超过一次 NSVT 发作（最多 5 次），平均心率为 221（48 次 b.p.m. 标准差）。出现运动性 NSVT/VF 的患者心肌肥厚程度更严重（22.6 毫米比 19.5 毫米，P=0.009），左心房更大（47.3 毫米比 43.7 毫米，P=0.03）。男性与运动性 NSVT/VF 显著相关[22（81.5%）比 832（61.5%），P=0.03]。8 名（29.6%）运动性 NSVT/VF 患者死亡或发生心脏事件（SD/ICD 放电/移植），而 150 名（11.1%）无运动性 NSVT/VF 患者发生，P=0.008。NSVT/VF 患者发生 SD/ICD 放电的风险增加 3.73 倍（HR 95%CI：1.61-8.63，P=0.002）。单独出现 NSVT/VF 与风险增加 2.82 倍相关（HR 95%CI：1.02-7.75，P=0.049）。在多变量分析中加入其他风险标志物后，运动性 NSVT/VF（而非单独 NSVT）与 SD/ICD 风险增加独立相关[HR 3.14（95%CI：1.29-7.61，P=0.01）]。