Turitto G, Fontaine J M, Ursell S N, Caref E B, Henkin R, el-Sherif N
Department of Medicine, State University of New York, Brooklyn 11203.
Am J Cardiol. 1988 Jun 1;61(15):1272-8. doi: 10.1016/0002-9149(88)91168-x.
A prospective assessment of several clinical variables, left ventricular function indexes, Holter recording characteristics and signal-averaged electrocardiogram (ECG) for their value in predicting the inducibility of sustained ventricular tachyarrhythmias was carried out in a consecutive series of 105 patients with nonsustained ventricular tachycardia (VT). The patients were divided into 3 groups based on the results of programmed electrical stimulation: group 1, 22 patients with induced sustained monomorphic VT; group 2, 14 patients with induced ventricular fibrillation (VF) and group 3, 69 patients with no induced sustained VT/VF. Left ventricular ejection fraction less than 0.40, history of syncope/presyncope and abnormal signal-averaged ECG were significantly more common in group 1 than in group 3. No significant difference was found between groups 2 and 3. The sensitivity, specificity and predictive accuracy of the signal-averaged ECG for the induction of sustained monomorphic VT were 64, 89 and 84%, respectively. Using stepwise discriminant function analysis, the signal-averaged ECG was found to be the single most accurate screening test to predict the inducibility of sustained VT in patients with nonsustained VT and its value was independent of the etiology of heart disease and the length of spontaneous runs. Because of the very high specificity and negative predictive accuracy, patients with normal signal-averaged ECGs may not require invasive evaluation.
对105例非持续性室性心动过速（VT）患者进行了一项前瞻性评估，分析了多个临床变量、左心室功能指标、动态心电图记录特征和信号平均心电图（ECG）在预测持续性室性心律失常诱发可能性方面的价值。根据程序电刺激结果将患者分为3组：第1组，22例诱发出持续性单形性VT的患者；第2组，14例诱发出心室颤动（VF）的患者；第3组，69例未诱发出持续性VT/VF的患者。第1组左心室射血分数低于0.40、晕厥/先兆晕厥病史以及异常信号平均心电图的情况明显比第3组更常见。第2组和第3组之间未发现显著差异。信号平均心电图对持续性单形性VT诱发的敏感性、特异性和预测准确性分别为64%、89%和84%。使用逐步判别函数分析发现，信号平均心电图是预测非持续性VT患者持续性VT诱发可能性的最准确的单项筛查试验，其价值独立于心脏病病因和自发发作的时长。由于具有非常高的特异性和阴性预测准确性，信号平均心电图正常的患者可能无需进行侵入性评估。
