Sawatari Hiroyuki, Ohkusa Tomoko, Rahamawati Anita, Ishikawa Katsuhiko, Tsuchihashi-Makaya Miyuki, Ohtsuka Yuko, Nakai Mori, Miyazono Mami, Hashiguchi Nobuko, Chishaki Hiroaki, Sakurada Harumizu, Mukai Yasushi, Inoue Shujiro, Sunagawa Kenji, Chishaki Akiko
Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Center for Clinical and Translational Research, Kyushu University, Fukuoka, Japan.
Clin Cardiol. 2016 May;39(5):263-8. doi: 10.1002/clc.22521. Epub 2016 May 6.
Implantable cardioverter-defibrillators (ICD) have provided effective therapy for fatal arrhythmia. However, ICD patients are known to develop psychological problems, such as posttraumatic stress disorder (PTSD), if they have experienced potentially fatal arrhythmia and ICD shocks. Little is known about the factors influencing PTSD in ICD patients.
Echocardiographic cardiac-function parameters might relate to psychological problems, especially PTSD, in ICD patients.
A total of 128 outpatients with ICD implantation completed the Impact of Event Scale Revised (IES-R) questionnaire as a measurement of PTSD. Demographic and clinical characteristic data were collected from medical records.
The mean age of the ICD patients was 59 ± 16 years; 103 were male; and the mean left ventricular ejection fraction (LVEF) by echocardiography was 52.4% ± 18.3%. In the ICD patients, female sex and impaired LVEF were related to lower IES-R scores or led to PTSD (P = 0.01 and P = 0.03, respectively). Impaired LVEF also worsened 2 symptoms of PTSD, intrusion (P = 0.02) and hyperarousal (P = 0.03). In patients with LVEF <35%, there was a significant negative correlation between LVEF level and IES-R score (P = 0.045).
This study showed that LVEF was related to the severity of PTSD, especially in the ICD patients with LVEF of <35%. We should pay more attention to ICD patients with severely impaired left ventricular function to prevent psychological problems.
植入式心脏复律除颤器（ICD）已为致命性心律失常提供了有效的治疗。然而，已知ICD患者如果经历过潜在致命性心律失常和ICD电击会出现心理问题，如创伤后应激障碍（PTSD）。关于影响ICD患者PTSD的因素知之甚少。
超声心动图心脏功能参数可能与ICD患者的心理问题，尤其是PTSD有关。
128例植入ICD的门诊患者完成了事件影响量表修订版（IES-R）问卷，作为PTSD的测量工具。从病历中收集人口统计学和临床特征数据。
ICD患者的平均年龄为59±16岁；103例为男性；超声心动图测得的平均左心室射血分数（LVEF）为52.4%±18.3%。在ICD患者中，女性和LVEF受损与较低的IES-R评分相关或导致PTSD（分别为P = 0.01和P = 0.03）。LVEF受损还使PTSD的两种症状，即侵入（P = 0.02）和过度觉醒（P = 0.03）恶化。在LVEF<35%的患者中，LVEF水平与IES-R评分之间存在显著负相关（P = 0.045）。
本研究表明LVEF与PTSD的严重程度相关，尤其是在LVEF<35%的ICD患者中。我们应更加关注左心室功能严重受损的ICD患者，以预防心理问题。
