新型冠状病毒肺炎患者室性早搏发生的预测因素

Predictors of Premature Ventricular Contractions Development in Patients With SARS-CoV-2 Infection.

作者信息

Tarzimanova Aida I, Bragina Anna E, Sokolova Ekaterina E, Vargina Tatiana S, Pokrovskaya Anna E, Safronova Tatiana A, Loriya Irakli Zh, Cherkesov Igor V, Cherepanov Alexander G, Ponomareva Liubov A, Vanina Daria D, Krylova Kseniya E, Ziskina Nadezhda K, Podzolkov Valery I

机构信息

The Second Internal Medicine (Second Faculty Therapy) Department, N.V. Sklifosovskiy Institute of Clinical Medicine, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.

Department of Plastic Surgery, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.

出版信息

J Clin Med Res. 2024 May;16(5):243-250. doi: 10.14740/jocmr5160. Epub 2024 May 29.

DOI:10.14740/jocmr5160

PMID:38855779

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11161186/

Abstract

BACKGROUND

Epidemiological studies have demonstrated that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-positive patients often develop atrial fibrillation, premature ventricular contractions (PVCs), and conduction disorders. The manifestation of ventricular cardiac arrhythmias accentuates the risk of sudden cardiac death.

METHODS

A retrospective study was conducted on the cohort of 1,614 patients admitted for coronavirus disease 2019 (COVID-19). Patients were categorized into two groups based on the occurrence of PVCs. Group I comprised 172 patients diagnosed with PVCs of Lown-Wolf class II - IV upon hospital admission; group II (control group) consisted of 1,442 patients without this arrhythmia. Each patient underwent comprehensive clinical, laboratory, and instrumental evaluations.

RESULTS

The emergence of PVCs in individuals afflicted with COVID-19 was associated with a 5.879-fold heightened risk of lethal outcome, a 2.904-fold elevated risk of acute myocardial infarction, and a 2.437-fold increased risk of pulmonary embolism. Upon application of diagnostic criteria to evaluate the "cytokine storm", it was discovered that the occurrence of the "cytokine storm" was notably more frequent in the group with PVCs, manifesting in six patients (3.5%), compared to 16 patients (1.1%) in the control group (P < 0.05). The mean extent of lung tissue damage in group I was significantly greater than that of patients in group II (P < 0.05). Notably, the average oxygen saturation level, as measured by pulse oximetry upon hospital admission was 92.63±3.84% in group I and 94.20±3.50% in group II (P < 0.05).

CONCLUSIONS

The presence of PVCs in COVID-19 patients was found to elevate the risk of cardiovascular complications. Significant independent predictors for the development of PVCs in patients with SARS-CoV-2 infection include: age over 60 years (risk ratio (RR): 4.6; confidence interval (CI): 3.2 - 6.5), a history of myocardial infarction (RR: 3.5; CI: 2.6 - 4.6), congestive heart failure (CHF) with reduced left ventricular ejection fraction (RR: 5.5; CI: 3.9 - 7.6), respiratory failure (RR: 2.3; CI: 1.7 - 3.1), and the presence of a "cytokine storm" (RR: 4.5; CI: 2.9 - 6.0).

摘要

背景

流行病学研究表明，严重急性呼吸综合征冠状病毒2（SARS-CoV-2）阳性患者常出现心房颤动、室性早搏（PVCs）和传导障碍。室性心律失常的表现会增加心源性猝死的风险。

方法

对1614例因2019冠状病毒病（COVID-19）入院的患者进行回顾性研究。根据是否发生PVCs将患者分为两组。第一组包括172例入院时被诊断为Lown-Wolf II-IV级PVCs的患者；第二组（对照组）由1442例无这种心律失常的患者组成。每位患者都接受了全面的临床、实验室和仪器评估。

结果

COVID-19患者中出现PVCs与死亡风险升高5.879倍、急性心肌梗死风险升高2.904倍以及肺栓塞风险升高2.437倍相关。应用诊断标准评估“细胞因子风暴”时发现，PVCs组中“细胞因子风暴”的发生明显更频繁，有6例患者出现（3.5%），而对照组有16例患者出现（1.1%）（P<0.05）。第一组肺组织损伤的平均程度明显大于第二组患者（P<0.05）。值得注意的是，入院时通过脉搏血氧饱和度测定的平均氧饱和度水平在第一组为92.63±3.84%，在第二组为94.20±3.50%（P<0.05）。

结论

发现COVID-19患者中存在PVCs会增加心血管并发症的风险。SARS-CoV-2感染患者发生PVCs的重要独立预测因素包括：60岁以上（风险比（RR）：4.6；置信区间（CI）：3.2 - 6.5）、心肌梗死病史（RR：3.5；CI：2.6 - 4.6）、左心室射血分数降低的充血性心力衰竭（CHF）（RR：5.5；CI：3.9 - 7.6）、呼吸衰竭（RR：2.3；CI：1.7 - 3.1）以及存在“细胞因子风暴”（RR：4.5；CI：2.9 - 6.0）。