Phan Derek, Aro Aapo L, Reinier Kyndaron, Teodorescu Carmen, Uy-Evanado Audrey, Gunson Karen, Jui Jonathan, Chugh Sumeet S
Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA.
Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland.
J Am Heart Assoc. 2016 Aug 18;5(8):e003715. doi: 10.1161/JAHA.116.003715.
Recent reports indicate that specific left ventricular (LV) geometric patterns predict recurrent ventricular arrhythmias in patients with implantable cardioverter-defibrillators and reduced left ventricular ejection fraction (LVEF). However, this relationship has not been evaluated among patients at risk of sudden cardiac arrest (SCA) in the general population.
Adult SCA cases from the Oregon Sudden Unexpected Death Study were compared with geographic controls with no prior history of SCA. Archived echocardiograms performed closest and prior to the SCA event were reviewed. LV geometry was defined as normal (normal LV mass index [LVMI] and relative wall thickness [RWT]), concentric remodeling (normal LVMI and increased RWT), concentric hypertrophy (increased LVMI and RWT), or eccentric hypertrophy (increased LVMI and normal RWT). Analysis was restricted to those with LVEF ≤40%. A total of 246 subjects were included in the analysis. SCA cases (n=172, 68.6±13.3 years, 78% male), compared to controls (n=74, 66.8±12.1 years, 73% male), had lower LVEF (29.4±7.9% vs 30.8±6.3%, P=0.021). Fewer cases presented with normal LV geometry (30.2% vs 43.2%, P=0.048) and more with eccentric hypertrophy (40.7% vs 25.7%, P=0.025). In a multivariate model, eccentric hypertrophy was independently predictive of SCA (OR 2.15, 95% CI 1.08-4.29, P=0.03).
Eccentric LV hypertrophy was independently associated with increased risk of SCA in subjects with EF ≤40%. These findings, now consistent between device-implanted and non-implanted populations, indicate the potential of improving SCA risk stratification from the same noninvasive echocardiogram at no additional cost.
近期报告表明，特定的左心室（LV）几何形态可预测植入式心脏复律除颤器患者及左心室射血分数（LVEF）降低患者的室性心律失常复发情况。然而，在普通人群中有心脏骤停（SCA）风险的患者中，这种关系尚未得到评估。
将俄勒冈州意外猝死研究中的成年SCA病例与无SCA既往史的地理对照人群进行比较。回顾了在SCA事件发生最近及之前进行的存档超声心动图。LV几何形态定义为正常（正常左心室质量指数[LVMI]和相对壁厚度[RWT]）、向心性重塑（正常LVMI且RWT增加）、向心性肥厚（LVMI和RWT增加）或离心性肥厚（LVMI增加且RWT正常）。分析仅限于LVEF≤40%的患者。共有246名受试者纳入分析。与对照组（n = 74，66.8±12.1岁，73%为男性）相比，SCA病例（n = 172，68.6±13.3岁，78%为男性）的LVEF较低（29.4±7.9%对30.8±6.3%，P = 0.021）。呈现正常LV几何形态的病例较少（30.2%对43.2%，P = 0.048），而离心性肥厚的病例较多（40.7%对25.7%，P = 0.025）。在多变量模型中，离心性肥厚独立预测SCA（OR 2.15，95%CI 1.08 - 4.29，P = 0.03）。
在EF≤40%的受试者中，离心性左心室肥厚与SCA风险增加独立相关。这些发现，现在在植入装置和未植入装置的人群中是一致的，表明有可能以不增加成本的方式通过相同的无创超声心动图改善SCA风险分层。
