Bender Seth R, Friedman Daniel J, Markowitz Steven M, Lerman Bruce B, Okin Peter M
Greenberg Division of Cardiology, Weill Cornell Medical College, 525 East 68 St., New York, NY 10065, USA.
J Interv Card Electrophysiol. 2012 Sep;34(3):237-45. doi: 10.1007/s10840-011-9661-2. Epub 2012 Feb 23.
The relatively low incidence of device-treated ventricular arrhythmias in patients with ischemic cardiomyopathy (ICM) who receive implantable cardioverter defibrillators (ICDs) for primary prevention makes improved risk stratification of ICM patients a priority. Although Cornell product (CP) ECG left ventricular hypertrophy (LVH) has been associated with increased mortality in hypertensive patients and population-based studies, whether CP LVH can improve risk stratification of high-risk ICM patients is unclear. The aim of this study is to examine if electrocardiographic LVH predicts mortality and incident ventricular arrhythmia in patients with ICM.
All-cause mortality was examined in 317 patients with ICM and a history of non-sustained ventricular tachycardia (VT) who underwent electrophysiology testing. Incident VT and ventricular fibrillation (VF) were assessed in ICD recipients (n = 186). ECG LVH was defined by CP criteria: [(R (aVL) + S (V3)) + 6 mm in women] × QRS duration >2,440 mm ms.
During 3 years of follow-up, mortality was 20% (64 of 317) and death or incident VT or VF occurred in 35% of ICD recipients. CP LVH was associated with significantly greater 3-year mortality (28% vs 15%, p = 0.015) and 3-year mortality or incident VT/VF in ICD patients (48% vs 35%, p = 0.011). In Cox multivariate models, CP LVH was an independent predictor of mortality in all patients (hazard ratio (HR) 1.81, 95% confidence interval (CI) 1.11-2.97, p = 0.020) and of the composite endpoint of mortality or incident ventricular arrhythmia in ICD patients (HR 1.82, 95% CI 1.12-3.00, p = 0.016).
ECG LVH using CP criteria may enhance risk stratification in high-risk patients with ICM.
在因一级预防而接受植入式心脏复律除颤器（ICD）的缺血性心肌病（ICM）患者中，经器械治疗的室性心律失常发生率相对较低，这使得改善ICM患者的风险分层成为当务之急。尽管康奈尔乘积（CP）心电图左心室肥厚（LVH）在高血压患者和基于人群的研究中与死亡率增加相关，但CP LVH能否改善高危ICM患者的风险分层尚不清楚。本研究的目的是检验心电图LVH是否可预测ICM患者的死亡率和室性心律失常事件。
对317例有非持续性室性心动过速（VT）病史且接受电生理检查的ICM患者进行全因死亡率检查。对ICD植入者（n = 186）评估室性心律失常事件和心室颤动（VF）。心电图LVH根据CP标准定义：[(R（aVL）+ S（V3）) + 女性6 mm]×QRS时限>2440 mm·ms。
在3年随访期间，死亡率为20%（317例中的64例），ICD植入者中有35%发生死亡或室性心律失常事件。CP LVH与3年死亡率显著更高相关（28%对15%，p = 0.015），且与ICD患者的3年死亡率或室性心律失常事件相关（48%对35%，p = 0.011）。在Cox多变量模型中，CP LVH是所有患者死亡率的独立预测因子（风险比（HR）1.81，95%置信区间（CI）1.11 - 2.97，p = 0.020），也是ICD患者死亡率或室性心律失常事件复合终点的独立预测因子（HR 1.82，95% CI 1.12 - 3.00，p = 0.016）。
采用CP标准的心电图LVH可能会增强高危ICM患者的风险分层。
