Piccirillo Gianfranco, Moscucci Federica, Fabietti Marcella, Parrotta Ilaria, Mastropietri Fabiola, Di Iorio Claudia, Sabatino Teresa, Crapanzano Davide, Vespignani Giulia, Mariani Marco Valerio, Salvi Nicolò, Magrì Damiano
Dipartimento di Scienze Cardiovascolari, Respiratorie, Geriatriche, Anestesiologiche e Nefrologiche, Policlinico Umberto I, "La Sapienza" University of Rome, Rome, Italy.
Dipartimento di Medicina Clinica e Molecolare, S. Andrea Hospital, "Sapienza" University of Rome, Rome, Italy.
Front Physiol. 2019 Aug 6;10:991. doi: 10.3389/fphys.2019.00991. eCollection 2019.
BACKGROUND/AIM: Degenerative aortic valve stenosis (AS) is associated to ventricular arrhythmias and sudden cardiac death, as well as mental stress in specific patients. In such a context, substrate, autonomic imbalance as well as repolarization dispersion abnormalities play an undoubted role. Aim of the study was to evaluate the increase of premature ventricular contractions (PVC) and complex ventricular arrhythmias during mental stress in elderly patients candidate to the transcatheter aortic valve replacement (TAVR).
In eighty-one elderly patients with AS we calculated several short-period RR- and QT-derived variables at rest, during controlled breathing and during mild mental stress, the latter being represented by a mini-mental state evaluation (MMSE).
All the myocardial repolarization dispersion markers worsened during mental stress ( < 0.05). Furthermore, during MMSE, low frequency component of the RR variability increased significantly both as absolute power (LF) and normalized units (LF ) ( < 0.05) as well as the low-high frequency ratio (LF/HF) ( < 0.05). Eventually, twenty-four (30%) and twelve (15%) patients increased significantly PVC and, respectively, complex ventricular arrhythmias during the MMSE administration. At multivariate logistic regression analysis, the standard deviation of QTend (QTe), obtained at rest, was predictive of increased PVC (odd ratio: 1.54, 95% CI 1.14-2.08; = 0.005) and complex ventricular arrhythmias (odd ratio: 2.31, 95% CI 1.40-3.83; = 0.001) during MMSE. The QTe showed the widest sensitive-specificity area under the curve for the increase of PVC (AUC: 0.699, 95% CI: 0.576-0.822, < 0.05) and complex ventricular arrhythmias (AUC: 0.801, 95% CI: 0.648-0.954, < 0.05).
In elderly with AS ventricular arrhythmias worsened during a simple cognitive assessment, this events being a possible further burden on the outcome of TAVR. QTe might be useful to identify those patients with the highest risk of ventricular arrhythmias. Whether the TAVR could led to a QTe reduction and, hence, to a reduction of the arrhythmic burden in this setting of patients is worthy to be investigated.
背景/目的：退行性主动脉瓣狭窄（AS）与室性心律失常、心源性猝死以及特定患者的精神压力有关。在这种情况下，心肌基质、自主神经失衡以及复极离散异常无疑起着重要作用。本研究的目的是评估拟行经导管主动脉瓣置换术（TAVR）的老年患者在精神压力下室性早搏（PVC）和复杂性室性心律失常的增加情况。
在81例AS老年患者中，我们计算了静息、控制呼吸和轻度精神压力期间（以简易精神状态检查表（MMSE）表示）几个短周期RR和QT衍生变量。
所有心肌复极离散标志物在精神压力期间均恶化（<0.05）。此外，在MMSE期间，RR变异性的低频成分无论是绝对功率（LF）还是标准化单位（LF）均显著增加（<0.05），低频与高频比值（LF/HF）也显著增加（<0.05）。最终，24例（30%）和12例（15%）患者在MMSE检查期间PVC和复杂性室性心律失常分别显著增加。在多因素逻辑回归分析中，静息时获得的QTend（QTe）标准差可预测MMSE期间PVC增加（比值比：1.54，95%可信区间1.14 - 2.08； = 0.005）和复杂性室性心律失常（比值比：2.31，95%可信区间1.40 - 3.83； = 0.001）。QTe在预测PVC增加（曲线下面积：0.699，95%可信区间：0.576 - 0.822，<0.05）和复杂性室性心律失常（曲线下面积：0.801，95%可信区间：0.648 - 0.954，<0.05）方面显示出最宽的敏感性 - 特异性曲线下面积。
在患有AS的老年患者中，简单的认知评估期间室性心律失常会恶化，这可能是TAVR结果的又一负担。QTe可能有助于识别室性心律失常风险最高的患者。TAVR是否能导致QTe降低，从而减轻这类患者的心律失常负担，值得进一步研究。
