舒张功能对心律失常性死亡预测的重要性：一项前瞻性、观察者盲法、长期研究。

Importance of Diastolic Function for the Prediction of Arrhythmic Death: A Prospective, Observer-Blinded, Long-Term Study.

机构信息

Department of Medicine II, Division of Cardiology, Medical University of Vienna, Austria (T.P., A.L.B., T.B.).

Departments of Medicine, Clinical Pharmacology, Pharmacology, and Neurology, Vanderbilt Autonomic Dysfunction Center, Nashville, TN (A.D.).

出版信息

Circ Arrhythm Electrophysiol. 2020 Feb;13(2):e007757. doi: 10.1161/CIRCEP.119.007757. Epub 2020 Jan 16.

DOI:10.1161/CIRCEP.119.007757

PMID:31944144

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7141079/

Abstract

BACKGROUND

Patients with ischemic or dilated cardiomyopathy and reduced left ventricular ejection fraction (LVEF) face a high risk for ventricular arrhythmias. Exact grading of diastolic function might improve risk stratification for arrhythmic death.

METHODS

We prospectively enrolled 120 patients with ischemic, 60 patients with dilated cardiomyopathy, and 30 patients with normal LVEF. Diastolic function was graded normal (N) or dysfunction grade I to III. Primary outcome parameter was arrhythmic death (AD) or resuscitated cardiac arrest (RCA).

RESULTS

Normal diastolic function was found in 23 (11%) patients, dysfunction grade I in 107 (51%), grade II in 31 (14.8%), and grade III in 49 (23.3%) patients, respectively. After an average follow-up of 7.0±2.6 years, AD or RCA was observed in 28 (13.3%) and 33 (15.7%) patients, respectively. Nonarrhythmic death was found in 41 (19.5%) patients. On Kaplan-Meier analysis, patients with dysfunction grade III had the highest risk for AD or RCA (<0.001). This finding was independent from the degree of LVEF dysfunction and was observed in patients with LVEF≤35% (=0.001) and with LVEF>35% (=0.014). Nonarrhythmic mortality was the highest in patients with dysfunction grade III. This was true for patients with LVEF≤35% (=0.009) or >35% (<0.001). In an adjusted model for relevant confounding factors, grade III dysfunction was associated with a 3.5-fold increased risk for AD or RCA in the overall study population (hazard ratio=3.52; <0.001).

CONCLUSIONS

Diastolic dysfunction is associated with a high risk for AD or RCA regardless if LVEF is ≤35% or >35%. Diastolic function grading might improve risk stratification for AD.

摘要

背景

患有缺血性或扩张型心肌病及左心室射血分数（LVEF）降低的患者发生室性心律失常的风险较高。准确分级舒张功能可能会改善心律失常性死亡的风险分层。

方法

我们前瞻性纳入 120 例缺血性心肌病患者、60 例扩张型心肌病患者和 30 例 LVEF 正常的患者。舒张功能分级正常（N）或功能障碍 I 至 III 级。主要终点参数为心律失常性死亡（AD）或复苏性心脏骤停（RCA）。

结果

分别有 23 例（11%）、107 例（51%）、31 例（14.8%）和 49 例（23.3%）患者存在正常舒张功能、I 级功能障碍、II 级功能障碍和 III 级功能障碍。平均随访 7.0±2.6 年后，分别有 28 例（13.3%）和 33 例（15.7%）患者发生 AD 或 RCA。41 例（19.5%）患者发生非心律失常性死亡。在 Kaplan-Meier 分析中，III 级功能障碍患者 AD 或 RCA 的风险最高（<0.001）。这种发现独立于 LVEF 功能障碍的严重程度，并且在 LVEF≤35%（=0.001）和 LVEF>35%（=0.014）的患者中观察到。III 级功能障碍患者的非心律失常性死亡率最高。这在 LVEF≤35%（=0.009）或>35%（<0.001）的患者中也是如此。在调整了相关混杂因素的模型中，在整个研究人群中，III 级功能障碍与 AD 或 RCA 的风险增加 3.5 倍相关（危险比=3.52；<0.001）。