Miranda Carlos Henrique, Schmidt André, Pazin-Filho Antônio
Division of Emergency Medicine, University of São Paulo Medical School at Ribeirão Preto, SP, Brazil.
Division of Cardiology of the Department of Internal Medicine, University of São Paulo Medical School at Ribeirão Preto, SP, Brazil.
Am J Emerg Med. 2014 Sep;32(9):1085-8. doi: 10.1016/j.ajem.2014.04.053. Epub 2014 May 12.
Multiple shocks of the implantable cardioverter/defibrillator (ICD) can cause myocardial injury, contributing to the progression of underlying heart disease. The aim was to evaluate if the elevation of troponin I after multiple ICD shocks has impact on the prognostic of these patients.
We evaluated patients with multiple ICD shocks (>3 shocks) in the last 24 hours. Troponin I was measured around 12 hours after the last shock. After this episode, these patients were followed; and events of death or heart failure hospitalization were recorded.
Twenty-six patients were included in the study. Elevation of troponin I occurred in 16 patients (62%), who had received a higher number of shocks (14 ± 9 vs 7 ± 4, P = .03) and greater cumulative total voltage (455 ± 345 J vs 141 ± 62 J, P = .03) compared to the group without elevation of this biomarker. We observed a positive correlation between troponin I and number of shocks (r = 0.70; P = .0001). Patients with troponin I elevation after multiple ICD shocks had higher risk of death or heart failure hospitalization (hazard ratio, 7.0; 95% confidence interval, 1.2-16.0; P = .03) compared with the group without elevation of this biomarker. After adjustment for age, sex, and number of shocks, the elevation of this biomarker remained as predictor of these events (hazard ratio, 16.0; 95% confidence interval, 1.7-151.0; P = .02).
A large proportion of patients with multiple ICD shocks have troponin I elevation, and these patients have a higher risk of death or hospitalization due to heart failure.
植入式心脏复律除颤器（ICD）多次电击可导致心肌损伤，促使潜在心脏病进展。目的是评估多次ICD电击后肌钙蛋白I升高是否对这些患者的预后有影响。
我们评估了在过去24小时内接受多次ICD电击（>3次电击）的患者。在最后一次电击后约12小时测量肌钙蛋白I。在这一事件后，对这些患者进行随访，并记录死亡或心力衰竭住院事件。
26例患者纳入研究。16例患者（62%）出现肌钙蛋白I升高，与未出现该生物标志物升高的组相比，这些患者接受的电击次数更多（14±9次对7±4次，P = 0.03），累积总电压更高（455±345焦耳对141±62焦耳，P = 0.03）。我们观察到肌钙蛋白I与电击次数之间呈正相关（r = 0.70；P = 0.0001）。与未出现该生物标志物升高的组相比，多次ICD电击后肌钙蛋白I升高的患者死亡或心力衰竭住院风险更高（风险比，7.0；95%置信区间，1.2 - 16.0；P = 0.03）。在调整年龄、性别和电击次数后，该生物标志物的升高仍然是这些事件的预测指标（风险比，16.0；95%置信区间，1.7 - 151.0；P = 0.02）。
大部分多次接受ICD电击的患者出现肌钙蛋白I升高，这些患者因心力衰竭死亡或住院的风险更高。
