Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.
Department of Advanced Cardiorhythm Therapeutics, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.
Clin Res Cardiol. 2024 Oct;113(10):1469-1477. doi: 10.1007/s00392-023-02343-9. Epub 2023 Dec 13.
Recent studies have shown that right ventricular dysfunction is associated with a significantly increased risk of sudden cardiac death. The purpose of this study was to evaluate the association of the right ventricular fractional area change (RVFAC) and appropriate implantable cardioverter-defibrillator (ICD) therapy to determine the cutoff value of the RVFAC.
Consecutive patients who underwent initial ICD implantations except those with hypertrophic cardiomyopathy, Brugada syndrome, and long QT syndrome were retrospectively enrolled. The primary endpoint was defined as any appropriate ICD therapy. The right ventricular dimensions and function on transthoracic echocardiography were measured for analysis.
In total, 172 patients (60.3 ± 13.6 years, 131 males) were enrolled. Ninety patients received an ICD as a secondary prophylaxis. The mean LV ejection fraction and RVFAC were 38.3 ± 14.3% and 35.8 ± 8.8%, respectively. Regarding appropriate ICD therapy events, the best cutoff value of the RVFAC was 34.8%, while 74 patients had an RVFAC < 34.8%. Regarding the primary endpoint, the hazard ratio of a low RVFAC was 2.73 (95% CI 1.46-5.12, P < 0.01). In the multivariate analysis, a low RVFAC was an independent predictor of appropriate ICD therapy (HR: 3.40, 95% CI 1.74-6.64, P < 0.01). The secondary prophylactic cohort with a low RVFAC had the highest incidence of appropriate ICD therapy. Among the patients with RV dysfunction, the RVFAC normalized in 39% of patients during follow-up. This recovered RVFAC group had a significantly lower incidence of appropriate ICD therapy than the unrecovered RVFAC group (P = 0.043).
A low RVFAC might be associated with increased appropriate ICD therapy.
最近的研究表明，右心室功能障碍与心脏性猝死的风险显著增加有关。本研究旨在评估右心室射血分数（RVFAC）与适当的植入式心脏复律除颤器（ICD）治疗的相关性，以确定 RVFAC 的截断值。
回顾性纳入了除肥厚型心肌病、Brugada 综合征和长 QT 综合征外，接受初始 ICD 植入的连续患者。主要终点定义为任何适当的 ICD 治疗。通过经胸超声心动图测量右心室的大小和功能进行分析。
共纳入 172 例患者（60.3±13.6 岁，131 例男性）。90 例患者因二级预防而接受 ICD 治疗。平均左心室射血分数和 RVFAC 分别为 38.3±14.3%和 35.8±8.8%。关于适当的 ICD 治疗事件，RVFAC 的最佳截断值为 34.8%，而 74 例患者的 RVFAC<34.8%。关于主要终点，低 RVFAC 的危险比为 2.73（95%CI 1.46-5.12，P<0.01）。在多变量分析中，低 RVFAC 是适当 ICD 治疗的独立预测因子（HR：3.40，95%CI 1.74-6.64，P<0.01）。低 RVFAC 的二级预防队列具有最高的适当 ICD 治疗发生率。在 RV 功能障碍患者中，39%的患者在随访期间 RVFAC 恢复正常。与未恢复 RVFAC 组相比，恢复 RVFAC 组的适当 ICD 治疗发生率显著降低（P=0.043）。
低 RVFAC 可能与适当的 ICD 治疗增加有关。
