左心室射血分数对植入式心脏复律除颤器患者复发性室性心律失常的影响。

Impact of Left Ventricular Ejection Fraction on Recurrent Ventricular Tachyarrhythmias in Recipients of Implantable Cardioverter Defibrillators.

机构信息

First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, Germany.

出版信息

Cardiology. 2020;145(6):359-369. doi: 10.1159/000504876. Epub 2020 Apr 14.

DOI:10.1159/000504876

PMID:32289772

Abstract

OBJECTIVE

This study evaluates the impact of left ventricular ejection fraction (LVEF) on recurrences of ventricular tachyarrhythmias in recipients of implantable cardioverter defibrillator (ICD).

BACKGROUND

Data regarding recurrences of ventricular tachyarrhythmias in ICD recipients according to LVEF is limited.

METHODS

A large retrospective registry was used, including all consecutive ICD recipients with episodes of ventricular tachycardia (VT) or fibrillation (VF) from 2002 to 2016. Patients with LVEF <35% were compared to patients with LVEF ≥35%. The primary end point was first recurrences of ventricular tachyarrhythmias at 5 years. Secondary end points were ICD-related therapies, rehospitalization, and all-cause mortality at 5 years. Cox regression, Kaplan Meier, and propensity score matching analyses were applied.

RESULTS

A total of 528 consecutive ICD recipients were included (51% with LVEF ≥35% and 49% with LVEF <35%). LVEF <35% was associated with reduced freedom from recurrent ventricular tachyarrhythmias (40 vs. 49%, log rank p = 0.014; hazard ratio [HR] = 1.381; 95% confidence interval [CI] 1.066-1.788; p = 0.034), mainly attributed to recurrent sustained VT in primary preventive ICD recipients. Accordingly, LVEF <35% was associated with reduced freedom from first appropriate ICD therapies (28 vs. 41%, log rank p = 0.001; HR = 1.810; 95% CI 1.185-2.766; p = 0.001). Finally, LVEF <35% was associated with a higher rate of rehospitalization (23 vs. 34%; p = 0.005) and all-cause mortality at 5 years (13 vs. 29%; p = 0.001).

CONCLUSION

LVEF <35% was associated with reduced freedom from recurrent ventricular tachyarrhythmias, appropriate device therapies, rehospitalization and all-cause mortality secondary to index ventricular tachyarrhythmias.

摘要

目的

本研究评估左心室射血分数（LVEF）对植入式心脏复律除颤器（ICD）接受者室性心动过速（VT）复发的影响。

背景

关于 ICD 接受者根据 LVEF 发生 VT 复发的数据有限。

方法

使用大型回顾性登记处，纳入 2002 年至 2016 年期间发生 VT 或纤维性颤动（VF）的所有连续 ICD 接受者。将 LVEF<35%的患者与 LVEF≥35%的患者进行比较。主要终点是 5 年内首次出现室性心动过速的复发。次要终点为 5 年内 ICD 相关治疗、再住院和全因死亡率。应用 Cox 回归、Kaplan-Meier 和倾向评分匹配分析。

结果

共纳入 528 例连续 ICD 接受者（51%的 LVEF≥35%，49%的 LVEF<35%）。LVEF<35%与降低无复发性室性心动过速的自由（40% vs. 49%，log rank p=0.014；风险比[HR]为 1.381；95%置信区间[CI]为 1.066-1.788；p=0.034）相关，主要归因于一级预防 ICD 接受者的持续性 VT 复发。因此，LVEF<35%与首次适当 ICD 治疗的自由降低相关（28% vs. 41%，log rank p=0.001；HR=1.810；95%CI 为 1.185-2.766；p=0.001）。最后，LVEF<35%与再住院率（23% vs. 34%）较高相关（p=0.005）和 5 年全因死亡率（13% vs. 29%）较高相关（p=0.001）。