左束支传导阻滞和血尿素氮的缺失可预测植入式心律转复除颤器的心肌病患者左心室射血分数的改善。
Absence of left bundle branch block and blood urea nitrogen predict improvement in left ventricular ejection fraction in patients with cardiomyopathy and wearable cardioverter defibrillators.
机构信息
Department of Cardiology, Lehigh Valley Health Network, Allentown, Pennsylvania.
Department of Cardiology, University of Nebraska Medical Center, Omaha, Nebraska.
出版信息
Clin Cardiol. 2020 Mar;43(3):260-266. doi: 10.1002/clc.23295. Epub 2019 Dec 20.
OBJECTIVE
To identify predictors of left ventricular ejection fraction (LVEF) improvement in patients with newly detected cardiomyopathy using wearable cardioverter defibrillators (WCDs).
BACKGROUND
WCDs are useful in preventing sudden cardiac death in patients with reduced LVEF <35% while awaiting implantable cardioverter defibrillator (ICD) placement. In many patients, LVEF improves and an ICD is not indicated.
METHODS
Patients who received WCDs from November 2013 to November 2015 were identified and followed over a period of 2 years. Clinical variables were examined. The primary outcome was improvement in LVEF ≥35%. Predictors of outcome were determined using a multivariate logistic regression model.
RESULTS
A total of 179 patients were followed. Median age was 65 (interquartile range [IQR]: 56, 73) years, 69.3% were men. Median baseline LVEF was 20% (IQR: 15, 30). LVEF improved ≥35% in 47.5% patients, with patients being younger (62 vs 68.5 years, P = .006), having lower blood urea nitrogen (BUN) (19 vs 24 mg/dL, P = .002), fewer left bundle branch block (LBBB 9.5% vs 25.8%, P = .004), shorter QRS duration (98 vs 112 ms, P < .001), and higher use of angiotensin converting enzyme inhibitors (ACEI)/angiotensin receptor blockers (ARB) (92.9% vs 74.4%, P = .001) compared to those without LVEF improvement. Absence of LBBB (odds ratio [OR] 0.28, 95% confidence interval [CI] 0.11-0.70), lower BUN (OR 0.13, 95% CI 0.02-0.76), and ACEI/ARB use (OR 3.53, 95% CI 1.28-9.69) were identified as independent predictors. Ventricular tachycardia/ventricular fibrillation was observed in three patients, all of whom received successful WCD shocks.
CONCLUSION
Absence of LBBB, lower BUN, and ACEI/ARB use predicts LVEF improvement. WCDs help treat arrhythmic events.
目的
利用可穿戴式除颤器（WCD）识别新发心肌病患者左心室射血分数（LVEF）改善的预测因素。
背景
在等待植入式心脏复律除颤器（ICD）放置时，WCD 可用于预防 LVEF<35%的降低的患者发生心源性猝死。在许多患者中，LVEF 会改善，而不需要 ICD。
方法
从 2013 年 11 月至 2015 年 11 月期间，确定接受 WCD 的患者并随访 2 年。检查临床变量。主要结局是 LVEF 改善≥35%。使用多变量逻辑回归模型确定结局的预测因素。
结果
共随访 179 例患者。中位年龄为 65（四分位距 [IQR]：56，73）岁，69.3%为男性。中位基线 LVEF 为 20%（IQR：15，30）。47.5%的患者 LVEF 改善≥35%，这些患者更年轻（62 岁 vs 68.5 岁，P=0.006），血尿素氮（BUN）更低（19 岁 vs 24 岁/分升，P=0.002），左束支传导阻滞（LBBB）较少（9.5% vs 25.8%，P=0.004），QRS 持续时间更短（98 岁 vs 112 岁/毫秒，P<.001），且更常使用血管紧张素转换酶抑制剂（ACEI）/血管紧张素受体阻滞剂（ARB）（92.9% vs 74.4%，P=0.001）。LVEF 无改善的患者中 LBBB 缺失（比值比 [OR]0.28，95%置信区间 [CI]0.11-0.70）、BUN 较低（OR 0.13，95% CI 0.02-0.76）和 ACEI/ARB 使用率（OR 3.53，95% CI 1.28-9.69）为独立预测因素。3 例患者发生室性心动过速/室颤，均接受了 WCD 成功电击。
结论
LBBB 缺失、BUN 降低和 ACEI/ARB 使用率可预测 LVEF 改善。WCD 有助于治疗心律失常事件。
Zotero 插件