心电图作为一级预防性植入式心律转复除颤器患者无不适当电击生存的预测指标：一项回顾性多中心研究。

Electrocardiogram as a predictor of survival without appropriate shocks in primary prophylactic ICD patients: A retrospective multi-center study.

作者信息

Pelli Ari, Kenttä Tuomas V, Junttila M Juhani, Bergau Leonard, Zabel Markus, Malik Marek, Reichlin Tobias, Willems Rik, Vos Marc A, Harden Markus, Friede Tim, Sticherling Christian, Huikuri Heikki V

机构信息

Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.

University Medical Center Göttingen Heart Center, Division of Cardiology, Göttingen, Germany.

出版信息

Int J Cardiol. 2020 Jun 15;309:78-83. doi: 10.1016/j.ijcard.2020.03.024. Epub 2020 Mar 10.

DOI:10.1016/j.ijcard.2020.03.024

PMID:32188583

Abstract

BACKGROUND

Abnormal 12-lead electrocardiogram (ECG) can predict cardiovascular events, including sudden cardiac death. We tested the hypothesis that ECG provides useful information on guiding implantable cardioverter defibrillator (ICD) therapy into individuals with impaired left ventricular ejection fraction (LVEF).

METHODS

Retrospective data of primary prevention ICD implantations from 14 European centers were gathered. The registry included 5111 subjects of whom 1687 patients had an interpretable pre-implantation ECG available (80.0% male, 63.3 ± 11.4 years). Primary outcome was survival without appropriate ICD shocks or heart transplantation. A low-risk ECG was defined as a combination of ECG variables that were associated with the primary outcome.

RESULTS

A total of 1224 (72.6%) patients survived the follow-up (2.9 ± 1.7 years) without an ICD shock, 224 (13.3%) received an appropriate shock and 260 (15.4%) died. Low-risk ECG defined as QRS duration <120 ms, QTc interval <450 ms for men and <470 ms for women, and sinus rhythm, were met by 515 patients (30.5%). Multivariable Cox regression showed that the hazard (HR) for death, heart transplantation or appropriate shock were reduced by 42.5% in the low-risk group (HR 0.575; 95% CI 0.45-0.74; p < 0.001), compared to the high-risk group. The HR for the first appropriate shock was 42.1% lower (HR 0.58; 95% CI 0.41-0.82; p = 0.002) and the HR for death was 48.0% lower (HR 0.52; 95% CI 0.386-0.72; p < 0.001) in the low-risk group.

CONCLUSION

Sinus rhythm, QRS <120 ms and normal QTc in standard 12-lead ECG provides information about survival without appropriate ICD shocks and might improve patient selection for primary prevention ICD therapy.

摘要

背景

12导联心电图（ECG）异常可预测心血管事件，包括心源性猝死。我们检验了这样一个假设，即心电图可为指导左心室射血分数（LVEF）受损个体植入植入式心律转复除颤器（ICD）治疗提供有用信息。

方法

收集了来自14个欧洲中心的一级预防ICD植入的回顾性数据。该登记册包括5111名受试者，其中1687例患者有可解读的植入前心电图（男性占80.0%，年龄63.3±11.4岁）。主要结局是未发生不适当的ICD电击或心脏移植而存活。低风险心电图定义为与主要结局相关的心电图变量组合。

结果

共有1224例（72.6%）患者在随访（2.9±1.7年）期间未发生ICD电击而存活，224例（13.3%）接受了适当电击，260例（15.4%）死亡。515例患者（30.5%）符合低风险心电图标准，即QRS时限<120ms，男性QTc间期<450ms，女性<470ms，且为窦性心律。多变量Cox回归显示，与高风险组相比，低风险组死亡、心脏移植或适当电击的风险（HR）降低了42.5%（HR 0.575；95%CI 0.45 - 0.74；p<0.001）。低风险组首次适当电击的HR降低了42.1%（HR 0.58；95%CI 0.41 - 0.82；p = 0.002），死亡的HR降低了48.0%（HR 0.52；95%CI 0.386 - 0.72；p<0.001）。