Viskin Dana, Halkin Amir, Sherez Jack, Megidish Ricki, Fourey Dana, Keren Gad, Topilsky Yan
Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Can J Cardiol. 2021 Oct;37(10):1562-1568. doi: 10.1016/j.cjca.2021.05.007. Epub 2021 May 21.
The causes of heart failure (HF) during high-grade atrioventricular block (AVB) are poorly understood. This study assessed the mechanisms of HF in patients with AVB.
We studied patients presenting (between 2012 and 2016) with high-grade AVB not related to acute myocardial infarction. Patients with preexisting significant valvular heart disease were excluded. All patients underwent comprehensive echocardiographic evaluation during AVB, before pacemaker implantation. The diagnosis of HF was based on the Framingham criteria.
A total of 122 patients were included in the study, 50% male, average age 76 ± 13 years. Twenty-eight patients (23%) with AVB presented with HF. Univariate correlates associated with HF were decrease in cardiac output (CO) (odds ratio [OR] 0.68 [95% confidence interval 0.49-0.9] per L/min; P = 0.007), measures of impaired left ventricular (LV) compliance, and increase in diastolic mitral regurgitation (MR) volume (OR 1.04 [1.01-1.07] per cc; P = 0.0016). Ventricular rate during AVB and LV ejection fraction were not significantly associated with the presence of HF. By multivariate nominal logistic analysis, the best model associated with HF included diastolic MR volume (OR 1.04 [1.001-1.09]; P = 0.02), A-wave deceleration time (OR 0.96 [0.94-0.9]; P = 0.001), and CO (OR 0.92 [0.4-1.00]; P = 0.005) (χ = 30.6; area under the receiver operating characteristic curve = 0.84; P < 0.0001 for the entire model).
In the setting of high-degree AVB, clinical HF occurrence correlates with impaired LV compliance and diastolic MR volume, but not with heart rate or LV ejection fraction. The cardiac performance of patients with poor LV compliance and high-volume diastolic MR may show maladjustment to slow heart rates, manifesting as low CO and HF.
高度房室传导阻滞（AVB）期间心力衰竭（HF）的病因尚不清楚。本研究评估了AVB患者发生HF的机制。
我们研究了2012年至2016年间出现的与急性心肌梗死无关的高度AVB患者。排除已有严重瓣膜性心脏病的患者。所有患者在AVB期间、起搏器植入前均接受了全面的超声心动图评估。HF的诊断基于弗明汉标准。
本研究共纳入122例患者，其中男性占50%，平均年龄76±13岁。28例（23%）AVB患者出现HF。与HF相关的单因素相关因素包括心输出量（CO）降低（每升/分钟比值比[OR]0.68[95%置信区间0.49 - 0.9]；P = 0.007）、左心室（LV）顺应性受损指标以及舒张期二尖瓣反流（MR）容积增加（每立方厘米OR 1.04[1.01 - 1.07]；P = 0.0016）。AVB期间的心室率和LV射血分数与HF的存在无显著相关性。通过多变量名义逻辑分析，与HF相关的最佳模型包括舒张期MR容积（OR 1.04[1.001 - 1.09]；P = 0.02）、A波减速时间（OR 0.96[0.94 - 0.9]；P = 0.001）和CO（OR 0.92[0.4 - 1.00]；P = 0.005）（χ = 30.6；受试者工作特征曲线下面积 = 0.84；整个模型P < 0.0001）。
在高度AVB情况下，临床HF的发生与LV顺应性受损和舒张期MR容积相关，但与心率或LV射血分数无关。LV顺应性差和舒张期MR容积大的患者的心脏功能可能对缓慢心率表现出适应不良，表现为低CO和HF。
