Filgueiras-Rama David, Calvo Conrado J, Salvador-Montañés Óscar, Cádenas Rosalía, Ruiz-Cantador Jose, Armada Eduardo, Rey Juan Ramón, Merino J L, Peinado Rafael, Pérez-Castellano Nicasio, Pérez-Villacastín Julián, Quintanilla Jorge G, Jiménez Santiago, Castells Francisco, Chorro Francisco J, López-Sendón J L, Berenfeld Omer, Jalife José, López de Sá Esteban, Millet José
Atherothrombosis, Imaging and Epidemiology Department, Fundación Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Hospital Clínico San Carlos, Madrid, Spain; Hospital Universitario La Paz, IdiPaz, Madrid, Spain.
Bio-ITACA Grupo de Bioingeniería, Instituto de Aplicaciones Avanzadas, Dpto Ingeniería Electrónica, Universitat Politècnica de Valencia, Spain; Grupo Electrofisiología y Bioingeniería, Microcluster en Protección Cardiovascular, Dpto de Medicina, Fundación INCLIVA Hospital Clínico, Valencia, Spain.
Int J Cardiol. 2015;186:250-8. doi: 10.1016/j.ijcard.2015.03.074. Epub 2015 Mar 14.
Early prognosis in comatose survivors after cardiac arrest due to ventricular fibrillation (VF) is unreliable, especially in patients undergoing mild hypothermia. We aimed at developing a reliable risk-score to enable early prediction of cerebral performance and survival.
Sixty-one out of 239 consecutive patients undergoing mild hypothermia after cardiac arrest, with eventual return of spontaneous circulation (ROSC), and comatose status on admission fulfilled the inclusion criteria. Background clinical variables, VF time and frequency domain fundamental variables were considered. The primary and secondary outcomes were a favorable neurological performance (FNP) during hospitalization and survival to hospital discharge, respectively. The predictive model was developed in a retrospective cohort (n = 32; September 2006-September 2011, 48.5 ± 10.5 months of follow-up) and further validated in a prospective cohort (n = 29; October 2011-July 2013, 5 ± 1.8 months of follow-up).
FNP was present in 16 (50.0%) and 21 patients (72.4%) in the retrospective and prospective cohorts, respectively. Seventeen (53.1%) and 21 patients (72.4%), respectively, survived to hospital discharge. Both outcomes were significantly associated (p < 0.001). Retrospective multivariate analysis provided a prediction model (sensitivity = 0.94, specificity = 1) that included spectral dominant frequency, derived power density and peak ratios between high and low frequency bands, and the number of shocks delivered before ROSC. Validation on the prospective cohort showed sensitivity = 0.88 and specificity = 0.91. A model-derived risk-score properly predicted 93% of FNP. Testing the model on follow-up showed a c-statistic ≥ 0.89.
A spectral analysis-based model reliably correlates time-dependent VF spectral changes with acute cerebral injury in comatose survivors undergoing mild hypothermia after cardiac arrest.
因心室颤动（VF）导致心脏骤停的昏迷幸存者的早期预后不可靠，尤其是在接受轻度低温治疗的患者中。我们旨在开发一种可靠的风险评分，以便能够早期预测脑功能和生存情况。
在239例心脏骤停后接受轻度低温治疗、最终恢复自主循环（ROSC）且入院时处于昏迷状态的连续患者中，61例符合纳入标准。考虑了背景临床变量、VF时间和频域基本变量。主要和次要结局分别为住院期间良好的神经功能表现（FNP）和存活至出院。预测模型在一个回顾性队列（n = 32；2006年9月至2011年9月，随访48.5±10.5个月）中开发，并在前瞻性队列（n = 29；2011年10月至2013年7月，随访5±1.8个月）中进一步验证。
回顾性队列和前瞻性队列中分别有16例（50.0%）和21例（72.4%）患者出现FNP。分别有17例（53.1%）和21例（72.4%）患者存活至出院。两种结局均显著相关（p < 0.001）。回顾性多变量分析提供了一个预测模型（敏感性 = 0.94，特异性 = 1），该模型包括频谱主导频率、衍生功率密度以及高频带和低频带之间的峰值比率，以及ROSC前给予的电击次数。在前瞻性队列中的验证显示敏感性 = 0.88，特异性 = 0.91。模型衍生的风险评分正确预测了93%的FNP。在随访中对模型进行测试显示c统计量≥0.89。
基于频谱分析的模型可靠地将心脏骤停后接受轻度低温治疗的昏迷幸存者中随时间变化的VF频谱变化与急性脑损伤相关联。
