在原发性预防 ICD 患者中，先前无症状非持续性室性心动过速对随后 ICD 干预和心力衰竭住院的临床意义。
Clinical significance of precedent asymptomatic non-sustained ventricular tachycardias on subsequent ICD interventions and heart failure hospitalization in primary prevention ICD patients.
机构信息
Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University, Moorenstrasse 5, 40225, Düsseldorf, Germany.
CARID, Cardiovascular Research Institute Düsseldorf, Medical Faculty, Heinrich-Heine-University, Moorensstrasse 5, 40225, Düsseldorf, Germany.
出版信息
Eur J Med Res. 2020 Mar 17;25(1):5. doi: 10.1186/s40001-020-0401-x.
BACKGROUND
The prognostic implications of non-sustained ventricular tachycardia (NSVT) and their significance as therapeutic targets in patients without prior sustained ventricular arrhythmias remain undetermined. The aim of this study was to investigate the prognostic significance of asymptomatic NSVT in patients who had primary prevention implantable cardioverter-defibrillator (ICD) implantation due to ischemic or non-ischemic cardiomyopathy (ICM, NICM).
METHODS
We enrolled 157 consecutive primary prevention ICD patients without previous appropriate ICD therapy (AIT). Patients were allocated to two groups depending on the presence or absence of NSVT in a 6-month period prior to enrollment. The incidence of AIT and unplanned hospitalization due to decompensated heart failure (HF) were assessed during follow-up.
RESULTS
In 51 patients (32%), precedent NSVT was documented. During a median follow-up of 1011 days, AIT occurred in 36 patients (23%) and unplanned HF hospitalization was observed in 32 patients (20%). In precedent NSVT patients, the incidence of AIT and unplanned HF hospitalization was significantly higher as compared to patients without precedent NSVT (AIT: 29/51 [57%] vs. 7/106 [7%], P < 0.001, log-rank; HF hospitalization: 16/51 [31%] vs. 16/106 [15%], P = 0.043, log-rank). Cox-regression demonstrated that precedent NSVT independently predicted AIT (P < 0.0001). In subgroup analyses, precedent NSVT predicted AIT in both ICM and NICM (P < 0.0001, P = 0.020), but predicted HF hospitalization only in patients with ICM (P = 0.0030).
CONCLUSIONS
Precedent non-sustained VT in patients with primary prevention ICDs is associated with subsequent appropriate ICD therapies, and is an independent predictor of unplanned heart failure hospitalizations in patients with ischemic cardiomyopathy.
背景
非持续性室性心动过速（NSVT）的预后意义及其作为无持续性室性心律失常既往史患者的治疗靶点的意义尚不确定。本研究旨在探讨因缺血性或非缺血性心肌病（ICM、NICM）而接受原发性预防植入式心脏复律除颤器（ICD）植入的患者无症状性 NSVT 的预后意义。
方法
我们纳入了 157 例因缺血性或非缺血性心肌病（ICM、NICM）而接受原发性预防 ICD 植入且既往无适当 ICD 治疗（AIT）的连续患者。根据患者在入组前 6 个月内是否存在 NSVT，将患者分为两组。在随访期间评估 AIT 和因心力衰竭（HF）失代偿而计划外住院的发生率。
结果
在 51 例（32%）患者中记录到存在先前的 NSVT。在中位随访 1011 天期间，36 例（23%）患者发生 AIT，32 例（20%）患者因 HF 失代偿而计划外住院。与无先前 NSVT 的患者相比，先前 NSVT 患者的 AIT 和计划外 HF 住院发生率显著更高（AIT：51/51 [57%] vs. 106/106 [7%]，P<0.001，对数秩检验；HF 住院：16/51 [31%] vs. 106/106 [15%]，P=0.043，对数秩检验）。Cox 回归分析表明，先前的 NSVT 独立预测 AIT（P<0.0001）。亚组分析显示，先前的 NSVT 预测 ICM 和 NICM 患者的 AIT（P<0.0001，P=0.020），但仅预测 ICM 患者的 HF 住院（P=0.0030）。
结论
原发性预防 ICD 患者先前的非持续性 VT 与随后的适当 ICD 治疗相关，是缺血性心肌病患者计划外心力衰竭住院的独立预测因子。
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