频发室性期前收缩患者不良预后的预测因素：ABC-VT 风险评分。
Predictors of adverse outcome in patients with frequent premature ventricular complexes: The ABC-VT risk score.
机构信息
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.
出版信息
Heart Rhythm. 2020 Jul;17(7):1066-1074. doi: 10.1016/j.hrthm.2020.02.020. Epub 2020 Feb 26.
BACKGROUND
No independently validated score currently exists for risk stratification of patients with frequent premature ventricular complexes (PVCs).
OBJECTIVES
The purpose of this study was to develop a risk score to predict adverse events in patients with frequent PVCs.
METHODS
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).
RESULTS
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.
CONCLUSION
The ABC-VT score is a simple tool that predicts adverse left ventricular remodeling and future clinical deterioration in patients with frequent PVCs.
背景
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。
目的
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。
方法
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）。
结果
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。
结论
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。
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