Ruwald Martin H, Moss Arthur J, Zareba Wojciech, Jons Christian, Ruwald Anne-Christine, McNitt Scott, Polonsky Bronislava, Kutyifa Valentina
Heart Research Follow-up Program, University of Rochester Medical Center, Rochester, New York, USA; Department of Cardiology, Gentofte Hospital, Hellerup, Denmark.
J Cardiovasc Electrophysiol. 2015 Mar;26(3):291-9. doi: 10.1111/jce.12592. Epub 2015 Jan 5.
It is unknown whether circadian variation of ventricular tachyarrhythmias (VTA) affects clinical outcome in heart failure patients.
A total of 1,790 patients (males 75%) with heart failure, NYHA class I and II and implantable cardioverter defibrillators (ICD) or cardiac resynchronization (CRT-D) enrolled in the MADIT-CRT study were included. Time of first and all VTAs as detected and treated by the device with appropriate ICD therapy (antitachycardia pacing or shock) was evaluated by hours of the day and weekdays and related to all-cause mortality using Cox regression analyses.
During a mean follow-up period of 40 months, a total of 3,300 VTA episodes were registered. Of all VTAs recorded, most of them (n = 2977, 90%) occurred in males. Recurrent as well as first VTA episodes were more common in the morning and evening with bimodal peaks from 7:00 to 10:59 (21%) and 18:00-21:59 (23%). VTAs that occurred during morning hours were associated with higher mortality when compared to VTA episodes occurring at other hours (hazard ratios [HR] = 2.07; confidence interval [CI]: 1.135-3.77; P = 0.018) with a significant gender interaction placing females at significantly higher risk of death (HR 6.78; CI 1.55-29.860; P = 0.011) than males (HR 1.79; CI 0.92-3.46; P = 0.086) (interaction P = 0.041) despite an overall lower probability for morning VTA among females (HR 0.32; CI 0.16-0.68; P = 0.003).
The occurrence of VTAs in heart failure patients shows a circadian variation with highest incidence during morning hours that translates into a significant higher risk of all-cause mortality, with significantly higher risk among females than males.
室性快速心律失常（VTA）的昼夜变化是否会影响心力衰竭患者的临床结局尚不清楚。
纳入了1790例心力衰竭患者（男性占75%），这些患者均为纽约心脏协会（NYHA）心功能I级和II级，且植入了植入式心律转复除颤器（ICD）或心脏再同步治疗装置（CRT-D），参与了多中心自动除颤器植入试验（MADIT-CRT）研究。通过一天中的小时数和工作日来评估首次及所有由设备检测到并接受适当ICD治疗（抗心动过速起搏或电击）的VTA的时间，并使用Cox回归分析将其与全因死亡率相关联。
在平均40个月的随访期内，共记录到3300次VTA发作。在所有记录的VTA中，大多数（n = 2977，90%）发生在男性身上。复发性以及首次VTA发作在早晨和晚上更为常见，双峰峰值出现在7:00至10:59（21%）和18:00 - 21:59（23%）。与其他时间段发生的VTA发作相比，早晨发生的VTA与更高的死亡率相关（风险比[HR] = 2.07；置信区间[CI]：1.135 - 3.77；P = 0.018），存在显著的性别交互作用，女性的死亡风险显著高于男性（HR 6.78；CI 1.55 - 29.860；P = 0.011）（HR 1.79；CI 0.92 - 3.46；P = 0.086）（交互作用P = 0.041），尽管女性早晨VTA的总体发生率较低（HR 0.32；CI 0.16 - 0.68；P = 0.003）。
心力衰竭患者中VTA的发生呈现昼夜变化，早晨发生率最高，这转化为全因死亡率显著更高的风险，女性的风险显著高于男性。
