Bandorski Dirk, Bogossian Harilaos, Stempfl Johanna, Seeger Werner, Hecker Matthias, Ghofrani Ardeschir, Hoeltgen Reinhard, Gall Henning
University of Giessen and Marburg Lung Center (UGMLC), The German Center for Lung Research (DZL), Klinikstrasse 33, 35392 Giessen, Germany.
Klinikum Lüdenscheid, Universität Witten-Herdecke, Medizinische Klinik III, Paulmannhöherstr. 14, 58515 Lüdenscheid, Germany.
Biomed Res Int. 2016;2016:1327265. doi: 10.1155/2016/1327265. Epub 2016 Dec 20.
Increased pulmonary vascular resistance in patients with pulmonary hypertension (PH) leads to an increased afterload of right heart and cardiac remodeling which could provide the substrate or trigger for arrhythmias. Supraventricular arrhythmias were associated with clinical deterioration but were not associated with sudden cardiac death (SCD). SCD has been reported to account for approximately 30% of deaths in patients with pulmonary arterial hypertension (PAH). The role of nonsustained ventricular tachycardia (nsVT) and its prognostic relevance in patients with PH remains unclear. This study evaluated the prognostic relevance of nsVT in patients with PAH and chronic thromboembolic pulmonary hypertension (CTEPH). Retrospectively, patients with PAH and CTEPH who underwent Holter ECG monitoring and available data of survival were investigated. Seventy-eight (PAH: 55, CTEPH: 23) patients were evaluated. Holter ECG revealed nsVT in 12 patients. Twenty-one patients died during follow-up. In patients with nsVT, tricuspid annular plane systolic excursion was lower ( = 0.001), and systolic pulmonary arterial pressure was higher ( = 0.163). Mean survival of patients without/with nsVT was 155.2 ± 8.5/146.4 ± 21.4 months ( = 0.690). The association between arrhythmias and survival was not confounded by age ( = 0.681), gender ( = 0.752), 6-MW distance ( = 0.196), or arterial hypertension ( = 0.238). In patients with PH, nsVT occurs more often than previously reported, and patients with PH group 1 seem to be more at risk.
肺动脉高压（PH）患者肺血管阻力增加会导致右心后负荷增加和心脏重塑，这可能为心律失常提供基础或诱因。室上性心律失常与临床病情恶化相关，但与心源性猝死（SCD）无关。据报道，SCD约占肺动脉高压（PAH）患者死亡人数的30%。非持续性室性心动过速（nsVT）在PH患者中的作用及其预后相关性仍不明确。本研究评估了nsVT在PAH和慢性血栓栓塞性肺动脉高压（CTEPH）患者中的预后相关性。对接受动态心电图监测且有生存数据的PAH和CTEPH患者进行回顾性研究。共评估了78例患者（PAH：55例，CTEPH：23例）。动态心电图显示12例患者存在nsVT。21例患者在随访期间死亡。存在nsVT的患者中，三尖瓣环平面收缩期位移较低（=0.001），而肺动脉收缩压较高（=0.163）。无/有nsVT患者的平均生存期分别为155.2±8.5/146.4±21.4个月（=0.690）。心律失常与生存之间的关联不受年龄（=0.681）、性别（=0.752）、6分钟步行距离（=0.196）或动脉高血压（=0.238）的影响。在PH患者中，nsVT的发生率比先前报道的更高，且第1组PH患者似乎风险更高。
