Draper Timothy S, Silver Jonathan S, Gaasch William H
Department of Cardiovascular Medicine, Lahey Hospital and Medical Center, Burlington, Massachusetts, and Tufts University School of Medicine, Boston, Massachusetts.
Department of Cardiovascular Medicine, Lahey Hospital and Medical Center, Burlington, Massachusetts, and Tufts University School of Medicine, Boston, Massachusetts.
J Card Fail. 2015 Feb;21(2):97-102. doi: 10.1016/j.cardfail.2014.10.018. Epub 2014 Nov 6.
The relationship of life-threatening ventricular arrhythmias to specific patterns of adverse LV remodeling has not been reported. We examined the relationship of ventricular tachycardia and/or fibrillation (VT/VF) to the pattern of left ventricular (LV) structural remodeling and to the degree of LV dysfunction in patients with a low ejection fraction (EF).
Data from 127 patients with a low EF (≤0.45) and an implantable cardioverter-defibrillator (ICD) were examined and VT/VF identified by means of ICD device interrogation. Echocardiographic data were used to define LV structural remodeling (eccentric hypertrophy, concentric remodeling/hypertrophy, and normal geometry). VT/VF occurred in 26% of the 127 patients. VT/VF was more common in the 60 patients with LV hypertrophy versus the 67 with normal LV mass (40% vs 13%; P = .001) and in the 61 patients with LV enlargement versus the 66 with a normal chamber size (34% vs 18%; P = .04). When LV chamber size, wall mass, and geometry were assessed in a combinatorial fashion, a Kaplan-Meier analysis indicated that the occurrence of VT/VF was highest in the patients with eccentric hypertrophy (43%), intermediate in those with concentric remodeling/hypertrophy (30%), and lowest (12%) in those with normal geometry (all P < .02). The EFs were similar (P = ns) in these 3 groups of distinctly different patterns of remodeling.
Life-threatening ventricular arrhythmias in patients with a low EF are related to the pattern of LV remodeling, not the degree of LV dysfunction. Risk stratification of such patients might be improved by a consideration of the pattern of LV remodeling.
危及生命的室性心律失常与左心室不良重构的特定模式之间的关系尚未见报道。我们研究了射血分数较低（EF）的患者中室性心动过速和/或心室颤动（VT/VF）与左心室（LV）结构重构模式及左心室功能障碍程度之间的关系。
对127例EF≤0.45且植入了植入式心脏复律除颤器（ICD）的患者的数据进行检查，并通过ICD设备问询来识别VT/VF。超声心动图数据用于定义左心室结构重构（离心性肥厚、向心性重构/肥厚和正常几何形态）。127例患者中有26%发生了VT/VF。与67例左心室质量正常的患者相比，6�例左心室肥厚患者中VT/VF更常见（40%对13%；P = 0.001）；与66例心室大小正常的患者相比，61例左心室扩大患者中VT/VF更常见（34%对18%；P = 0.04）。当以组合方式评估左心室腔大小、壁质量和几何形态时，Kaplan-Meier分析表明，离心性肥厚患者中VT/VF的发生率最高（43%），向心性重构/肥厚患者中次之（30%），正常几何形态患者中最低（12%）（所有P < 0.02）。这3组明显不同重构模式的患者的EF相似（P = 无显著性差异）。
EF较低的患者中危及生命的室性心律失常与左心室重构模式有关，而非左心室功能障碍程度。考虑左心室重构模式可能会改善此类患者的危险分层。
