Candan O, Gecmen C, Kalaycı A, Bayam E, Guner A, Gunduz S, Cersit S, Ozkan M
Cardiology Clinic, Kartal Kosuyolu Heart Training and Research Hospital, 34846, Kartal, İstanbul, Turkey.
Herz. 2019 May;44(3):238-246. doi: 10.1007/s00059-017-4633-7. Epub 2017 Oct 16.
We investigated the efficacy of clinical and classic echocardiographic parameters in predicting the occurrence of nonsustained ventricular tachycardia (NsVT) in patients with hypertrophic cardiomyopathy (HCM).
The study comprised 59 patients with HCM (47 male, [80%]; mean age, 48.48 ± 14.16 years). Clinical, electrocardiographic, as well as classic two-dimensional and speckle-tracking echocardiography (STE) data were collected. All patients had Holter monitoring within 24-72 h of the echocardiographic examination. NsVT was defined as three or more consecutive premature wide QRS complexes with a heart rate of > 100 bpm. The patient population was categorized into groups based on the occurrence or absence of NsVT on the 24-h Holter recordings.
NsVT was observed in 17 patients (29%). In these patients, higher twist (14.4 ± 3.8 vs.18 ± 7.9; p = 0.02), higher apical rotation (8.7 ± 4.2 vs. 12.2 ± 7; p = 0.02), higher sudden cardiac death risk score (4.4 ± 2.2 vs. 7 ± 3.3; p = 0.007), and decreased global longitudinal peak strain (GLPS; -12.8 ± 3.1 vs. -10.6 ± 2.8; p = 0.014) were observed. In the multivariate logistic regression analysis, including GLPS and twist, GLPS (Odds Ratio [OR]: 1.406; 95% CI: 1.087-1.818; p = 0.009) and twist (OR: 1.236; 95% CI: 1.056-1.446; p = 0.008) were found to be independent predictors of NsVT. In the receiver operating characteristic curve analysis, GLPS < -11.9% predicted NsVT with 82% sensitivity and 60% specificity (area under the curve [AUC]: 0.70; p = 0.014) and twist > 15.2° predicted NsVT with 70% sensitivity and 58% specificity (AUC: 0.69; p = 0.027).
Decreased GLPS and increased twist were predictive of NsVT in HCM patients. Parameters that can easily be measured with STE can help detect patients who may develop arrhythmia.
我们研究了临床及传统超声心动图参数对肥厚型心肌病（HCM）患者非持续性室性心动过速（NsVT）发生的预测效能。
本研究纳入了59例HCM患者（47例男性，占80%；平均年龄48.48±14.16岁）。收集了临床、心电图以及传统二维和斑点追踪超声心动图（STE）数据。所有患者在超声心动图检查后24 - 72小时内进行动态心电图监测。NsVT定义为连续三个或更多宽大QRS波群早搏，心率>100次/分。根据24小时动态心电图记录中NsVT的发生情况将患者人群分为两组。
17例患者（29%）观察到NsVT。在这些患者中，发现扭转角度更高（14.4±3.8对18±7.9；p = 0.02）、心尖旋转角度更高（8.7±4.2对12.2±7；p = 0.02）、心脏性猝死风险评分更高（4.4±2.2对7±3.3；p = 0.007）以及整体纵向峰值应变（GLPS）降低（-12.8±3.1对-10.6±2.8；p = 0.014）。在多因素逻辑回归分析中，纳入GLPS和扭转角度，发现GLPS（比值比[OR]：1.406；95%可信区间[CI]：1.087 - 1.818；p = 0.009）和扭转角度（OR：1.236；95%CI：1.056 - 1.446；p = 0.008）是NsVT的独立预测因素。在受试者工作特征曲线分析中，GLPS < -11.9%预测NsVT的敏感度为82%，特异度为60%（曲线下面积[AUC]：0.70；p = 0.014），扭转角度>15.2°预测NsVT的敏感度为70%，特异度为58%（AUC：0.69；p = 0.027）。
GLPS降低和扭转角度增加可预测HCM患者发生NsVT。STE能够轻松测量的参数有助于检测可能发生心律失常的患者。
