Division of Cardiology, University of California San Francisco, San Francisco, California.
Division of Cardiology, University of California San Francisco, San Francisco, California; Division of Cardiology, Kosin University Gospel Hospital, Busan, Republic of Korea.
Heart Rhythm. 2020 Jul;17(7):1066-1074. doi: 10.1016/j.hrthm.2020.02.020. Epub 2020 Feb 26.
No independently validated score currently exists for risk stratification of patients with frequent premature ventricular complexes (PVCs).
The purpose of this study was to develop a risk score to predict adverse events in patients with frequent PVCs.
We analyzed consecutive patients between 2012 and 2017 undergoing 14-day continuous monitoring with frequent PVCs (>5%) and concurrent echocardiography. We performed binary logistic regression to determine multivariate predictors of adverse left ventricular remodeling (left ventricular ejection fraction [LVEF] <45% or left ventricular end-diastolic volume index >75 mL/m). A risk score was created using the log(odds ratio (OR)) of these predictors and validated prospectively to determine the risk of future adverse events in those with baseline LVEF >45%. An adverse event was defined as LVEF decline by 10%, heart failure hospitalization, or cardiovascular mortality. Two validation cohorts were used: follow-up from the original derivation cohort (cohort 1) and an independent Korean PVC registry (cohort 2).
The derivation cohort comprised 206 patients with a mean PVC burden of 11.6% ± 6.2% and considerable daily fluctuation (minimum burden 7.3% ± 6.2% vs maximum 17.9% ± 8.0%). Independent predictors of adverse remodeling were as follows: superiorly directed PVC axis (OR 2.7; 1 point), PVC burden 10%-20% (OR 3.5; 2 points) and >20% (OR 4.4; 3 points), PVC coupling interval >500 ms (OR 4.7; 4 points), nonsustained ventricular tachycardia (OR 5.3; 4 points), which form the ABC-VT risk score. This score predicted future adverse events in both validation cohorts: cohort 1, hazard ratio 1.43; 95% confidence interval 1.19-1.73; P < .001 and cohort 2, hazard ratio 1.22; 95% confidence interval 1.05-1.42; P = .01.
The ABC-VT score is a simple tool that predicts adverse left ventricular remodeling and future clinical deterioration in patients with frequent PVCs.
目前尚无用于频发室性早搏（PVCs）患者风险分层的独立验证评分。
本研究旨在开发一种风险评分，以预测频发 PVCs 患者的不良事件。
我们分析了 2012 年至 2017 年间连续接受 14 天频发 PVCs（>5%）和同步超声心动图监测的患者。我们进行了二元逻辑回归分析，以确定不良左心室重构（左心室射血分数 [LVEF] <45%或左心室舒张末期容积指数>75 mL/m）的多变量预测因子。使用这些预测因子的对数（优势比 [OR]）创建风险评分，并前瞻性验证其在基线 LVEF >45%的患者中预测未来不良事件的风险。不良事件定义为 LVEF 下降 10%、心力衰竭住院或心血管死亡率。使用两个验证队列：原始推导队列的随访（队列 1）和独立的韩国 PVC 登记处（队列 2）。
推导队列包括 206 例患者，平均 PVC 负荷为 11.6%±6.2%，且具有相当大的日常波动（最低负荷 7.3%±6.2%与最高负荷 17.9%±8.0%）。不良重构的独立预测因子如下：指向上方的 PVC 轴（OR 2.7；1 分）、PVC 负荷 10%-20%（OR 3.5；2 分）和>20%（OR 4.4；3 分）、PVC 耦合间隔>500 ms（OR 4.7；4 分）、非持续室性心动过速（OR 5.3；4 分），构成 ABC-VT 风险评分。该评分在两个验证队列中均预测了未来的不良事件：队列 1，风险比 1.43；95%置信区间 1.19-1.73；P<0.001 和队列 2，风险比 1.22；95%置信区间 1.05-1.42；P=0.01。
ABC-VT 评分是一种简单的工具，可预测频发 PVCs 患者的不良左心室重构和未来临床恶化。
