老年人群中室性早搏心肌病的转归：CHF-STAT 研究的二次分析。
Outcomes of Premature Ventricular Contraction-Cardiomyopathy in the Veteran Population: A Secondary Analysis of the CHF-STAT Study.
机构信息
Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Virginia, USA; Virginia Commonwealth University/Pauley Heart Center, Richmond, Virginia, USA.
Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, USA.
出版信息
JACC Clin Electrophysiol. 2021 Mar;7(3):380-390. doi: 10.1016/j.jacep.2020.08.028. Epub 2020 Nov 25.
OBJECTIVES
This study sought to assess the rate and outcomes of premature ventricular contractions (PVC)-cardiomyopathy from the CHF-STAT (Survival Trial of Antiarrhythmic Therapy in Congestive Heart Failure) trial, a population with cardiomyopathy (left ventricular [LV] ejection fraction of <40%) and frequent PVCs (>10 PVCs per hour).
BACKGROUND
PVCs are associated with heart failure and PVC-cardiomyopathy. The prevalence of PVC-cardiomyopathy and outcome benefits of PVC suppression are not clear.
METHODS
A secondary analysis of the CHF-STAT study was performed to compare the rate of successful PVC suppression (≥80% PVC reduction), LV recovery (defined as improvement in LV ejection fraction of ≥10% points), and PVC-cardiomyopathy between amiodarone and placebo groups at 6 months. PVC-cardiomyopathy was defined if both PVC reduction of ≥80% and LV ejection fraction improvement of ≥10% were present at 6 months. Cardiac events (death or resuscitated cardiac arrest) were compared between PVC-cardiomyopathy versus non-PVC-cardiomyopathy during a 5-year follow-up.
RESULTS
The rates of successful PVC suppression and LV recovery were significantly higher in the amiodarone (72% and 39%, respectively) when compared to the placebo group (12% and 16%, respectively; p < 0.001), regardless of cardiomyopathy etiology. PVC-cardiomyopathy was present in 29% and 1.8% of patients in the amiodarone and placebo groups, respectively (p < 0.001). Similar PVC-cardiomyopathy rates were found in ischemic (24% amiodarone vs. 2% placebo; p < 0.001) and nonischemic populations (41% amiodarone vs. 1.5% placebo; p < 0.001). Death and resuscitated cardiac arrest were significantly lower in patients with PVC-cardiomyopathy and those treated with amiodarone.
CONCLUSIONS
The overall prevalence of PVC-cardiomyopathy in the CHF-STAT study was significant regardless of ischemic substrate (29%, overall population; 41%, nonischemic cardiomyopathy). Treatment of PVC-cardiomyopathy with amiodarone is likely to improve survival in this high-risk population.
目的
本研究旨在评估 CHF-STAT（充血性心力衰竭抗心律失常治疗生存试验）试验中频发室性早搏（PVC）心肌病的发生率和结局，该试验人群患有心肌病（左心室 [LV]射血分数<40%）和频发 PVC（每小时>10 个 PVC）。
背景
PVC 与心力衰竭和 PVC 心肌病相关。PVC 心肌病的患病率和 PVC 抑制的获益尚不清楚。
方法
对 CHF-STAT 研究进行二次分析，比较胺碘酮组和安慰剂组在 6 个月时成功抑制 PVC（≥80% PVC 减少）、LV 恢复（定义为 LV 射血分数改善≥10%）和 PVC 心肌病的发生率。如果 6 个月时存在≥80%的 PVC 减少和≥10%的 LV 射血分数改善，则定义为 PVC 心肌病。在 5 年随访期间，比较 PVC 心肌病与非 PVC 心肌病之间的心脏事件（死亡或复苏性心脏骤停）。
结果
胺碘酮组成功抑制 PVC 的发生率（72%）和 LV 恢复的发生率（39%）显著高于安慰剂组（分别为 12%和 16%；p<0.001），而与心肌病病因无关。胺碘酮组和安慰剂组分别有 29%和 1.8%的患者存在 PVC 心肌病（p<0.001）。在缺血性（胺碘酮 24%比安慰剂 2%；p<0.001）和非缺血性人群（胺碘酮 41%比安慰剂 1.5%；p<0.001）中也发现了相似的 PVC 心肌病发生率。患有 PVC 心肌病和接受胺碘酮治疗的患者的死亡和复苏性心脏骤停发生率显著降低。
结论
无论缺血性底物如何（总体人群为 29%，非缺血性心肌病为 41%），CHF-STAT 研究中 PVC 心肌病的总体患病率均较高。用胺碘酮治疗 PVC 心肌病可能会改善这一高危人群的生存率。
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