Kim Minsu, Kim Jun, Lee Ji Hyun, Hwang You Mi, Kim Min-Seok, Nam Gi-Byoung, Choi Kee-Joon, Kim Jae-Joong, Kim You-Ho
Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
J Cardiovasc Electrophysiol. 2016 Oct;27(10):1191-1198. doi: 10.1111/jce.13037. Epub 2016 Jul 15.
Data are lacking on the relationship between improved left ventricular ejection fraction (LVEF) and the incidence of ventricular arrhythmia in patients with an implantable cardioverter-defibrillator (ICD) for secondary prevention. The aim of this study was to evaluate the incidence and predictors of improvement in left ventricular (LV) function and determine the impact of improved LVEF on the occurrence of appropriate ICD therapy in patients with reduced LVEF and ICD for secondary prevention.
In this study, 93 patients who received ICDs for secondary prevention, had an LVEF of < 45%, and underwent echocardiographic follow-up assessment after receiving an ICD were enrolled.
The mean patient age was 56.9 ± 13.1 years, the median time of repeat LVEF assessment was 19.7 (10.4-29.7) months, and the mean LVEF was 30.6 ± 8.5%. Of the patients, 58 (62.4%) had nonischemic cardiomyopathy. LV function improved after ICD implantation in 24 (25.8%) of 93 patients. Multivariable logistic regression revealed a short duration from the time of diagnosis of heart failure to ICD implantation and the presence of ventricular fibrillation as significant predictors of improved LV function. The incidence of appropriate ICD therapy was lower in the patients with than in those without LV function improvement. The composite endpoint of all-cause mortality or heart transplant was lower in the patients with than in those without LV function improvement.
Overall survival was better and the recurrence of ventricular arrhythmia was lower in the patients with improved LV function.
对于植入式心脏复律除颤器（ICD）用于二级预防的患者，左心室射血分数（LVEF）改善与室性心律失常发生率之间的关系尚缺乏相关数据。本研究的目的是评估左心室（LV）功能改善的发生率及预测因素，并确定LVEF改善对LVEF降低且植入ICD用于二级预防的患者发生适当ICD治疗的影响。
本研究纳入了93例接受ICD用于二级预防、LVEF<45%且在植入ICD后接受超声心动图随访评估的患者。
患者的平均年龄为56.9±13.1岁，重复LVEF评估的中位时间为19.7（10.4 - 29.7）个月，平均LVEF为30.6±8.5%。其中58例（62.4%）患者患有非缺血性心肌病。93例患者中有24例（25.8%）在植入ICD后LV功能得到改善。多变量逻辑回归显示，从心力衰竭诊断到ICD植入的时间较短以及存在室颤是LV功能改善的显著预测因素。LV功能改善的患者中适当ICD治疗的发生率低于未改善的患者。LV功能改善的患者全因死亡或心脏移植的复合终点低于未改善的患者。
LV功能改善的患者总体生存率更高，室性心律失常的复发率更低。
