药物致心力衰竭保留射血分数患者心室复极离散度增加。
Drug-induced increase in dispersion of ventricular repolarization in patients with heart failure with preserved ejection fraction.
机构信息
College of Pharmacy, Purdue University, Indianapolis, IN, United States.
College of Pharmacy, Purdue University, Indianapolis, IN, United States; Division of Clinical Pharmacology, School of Medicine, Indiana University, Indianapolis, IN, United States.
出版信息
Int J Cardiol. 2025 Jan 1;418:132631. doi: 10.1016/j.ijcard.2024.132631. Epub 2024 Oct 10.
BACKGROUND
Heart failure (HF) with preserved ejection fraction (HFpEF) is associated with enhanced response to drug-induced QT interval lengthening. We determined the influence of HFpEF on drug-induced lengthening of dispersion of repolarization, a measure of proarrhythmic risk.
METHODS
We administered intravenous ibutilide 0.003 mg/kg to 10 patients with HFpEF and 10 age- and sex-matched controls without HF. Twelve‑lead electrocardiograms were obtained prior to ibutilide and serially for 8 h post-ibutilide. Tpeak-Tend, a measure of dispersion of ventricular repolarization, and heart rate-corrected J-Tpeak (J-Tpeakc), representing early repolarization, were measured by an investigator blinded to study groups.
RESULTS
Baseline (pre-ibutilide) Tpeak-Tend and J-Tpeakc were not significantly different in the HFpEF and control groups. Maximum Tpeak-Tend was longer in the HFpEF group than in the control group (85 ± 10 vs 73 ± 8 ms, p = 0.01). Additionally, % change from baseline in Tpeak-Tend was greater in the HFpEF group [median (IQR) 17 (11) vs 8 (3)%, p = 0.003]. The area under the effect curve from 0 to 8 hours following ibutilide (including the 10-minute infusion) (AUEC) for Tpeak-Tend was also larger in the HFpEF group (600 ± 42 vs. 543 ± 49 ms•hr, p = 0.03). Maximum J-Tpeakc, % change from baseline in J-Tpeakc and AUEC for J-Tpeakc in the two groups were not significantly different.
CONCLUSION
HFpEF is associated with enhanced response to drug-induced increases in dispersion of repolarization.
背景
射血分数保留的心力衰竭（HFpEF）与药物引起的 QT 间期延长的反应增强有关。我们确定了 HFpEF 对复极离散度（一种致心律失常风险的测量指标）药物诱导延长的影响。
方法
我们给 10 例 HFpEF 患者和 10 例年龄和性别匹配的无 HF 对照患者静脉注射 0.003mg/kg 的伊布利特。在伊布利特前和伊布利特后 8 小时内获取 12 导联心电图。通过一位对研究组不知情的研究者测量 Tpeak-Tend（心室复极离散度的测量指标）和心率校正的 J-Tpeak（J-Tpeakc），代表早期复极。
结果
HFpEF 组和对照组的基线（伊布利特前）Tpeak-Tend 和 J-Tpeakc 无显著差异。HFpEF 组的最大 Tpeak-Tend 长于对照组（85±10 比 73±8ms，p=0.01）。此外，HFpEF 组 Tpeak-Tend 从基线的变化百分比更大[中位数（IQR）17（11）比 8（3）%，p=0.003]。伊布利特后 0 至 8 小时（包括 10 分钟输注）的 Tpeak-Tend 效应曲线下面积（AUEC）在 HFpEF 组也更大（600±42 比 543±49ms·hr，p=0.03）。两组的最大 J-Tpeakc、J-Tpeakc 从基线的变化百分比和 J-Tpeakc 的 AUEC 没有显著差异。
结论
HFpEF 与药物引起的复极离散度增加的反应增强有关。
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