充血性心力衰竭或心肌梗死患者心脏结局的无创风险评估与预测

Noninvasive risk assessment and prediction of cardiac outcomes in patients with congestive heart failure or myocardial infarction.

作者信息

Kim Ju Youn, Park Young Jun, Park Seung-Jung, Kim Juwon, Park Kyoung-Min, On Young Keun, Kim June Soo, Nam Gi-Byoung, Lee Young Soo, Kim Dae Hyeok, Ahn Minsoo, Shin Dong-Gu, Kim Nam-Ho, Namgung June, Park Yae Min, Park Hyoung-Seob

机构信息

Division of Cardiology, Department of Internal Medicine, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Wonju Severance Christian Hospital, Department of Internal Medicine, Yonsei University, Wonju College of Medicine, Wonju, Republic of Korea.

出版信息

Heart Rhythm. 2025 Apr;22(4):1030-1039. doi: 10.1016/j.hrthm.2024.10.012. Epub 2024 Oct 10.

DOI:10.1016/j.hrthm.2024.10.012

PMID:39395571

Abstract

BACKGROUND

Heart rate turbulence (HRT) and T-wave alternans (TWA), recognized as promising noninvasive markers for ventricular tachyarrhythmias and cardiac death, have been studied predominantly in Western populations, specifically in patients with myocardial infarction (MI) or heart failure (HF) with reduced ejection fraction (EF).

OBJECTIVE

The purpose of this study was to investigate the clinical implications of HRT and TWA in predicting adverse cardiac events, including cardiac death, ventricular tachyarrhythmia, and heart failure-related hospitalization (HFH).

METHODS

The K-REDEFINE study, a prospective, observational, multicenter analysis of 26 tertiary hospitals in South Korea, investigated the prognostic implications of Holter-based variables including HRT and TWA in 1116 patients with acute MI or HF (age 60.8 ± 2.9 years; 76.3% male). All participants underwent 24-hour Holter recording within 6.8 ± 16.5 days after hospitalization. The primary composite outcome included cardiac death, ventricular tachyarrhythmias, and HFH.

RESULTS

During 4.3 ± 1.2 years of follow-up, impaired HRT demonstrated the most powerful predictive value for the composite (adjusted hazard ratio [aHR] 3.41, 95% confidence interval [CI] 2.27-5.13) or individual events: cardiac death (aHR 4.08, 95% CI 2.17-7.70), ventricular tachyarrhythmia (aHR 3.72, 95% CI 1.29-10.77), and HFH (aHR 4.32, 95% CI 2.25-8.28). The predictive power of abnormal HRT remained consistently significant across subgroups of MI and HF, or across varying degrees of EF. When combined with reduced EF (<50%), the predictive power was further enhanced. However, abnormal TWA was significantly associated only with the composite outcome (aHR 1.51, 95% CI 1.06-2.16).

CONCLUSION

The K-REDEFINE study identified abnormal HRT, mostly assessed within 1 month after hospitalization, as a significant predictor not only for cardiac death and ventricular tachyarrhythmia but also for HFH.

摘要

背景

心率震荡（HRT）和T波电交替（TWA）被认为是预测室性快速心律失常和心源性死亡的有前景的无创标志物，主要在西方人群中进行了研究，特别是在心肌梗死（MI）或射血分数降低（EF）的心力衰竭（HF）患者中。

目的

本研究旨在探讨HRT和TWA在预测不良心脏事件（包括心源性死亡、室性快速心律失常和心力衰竭相关住院（HFH））中的临床意义。

方法

K-REDEFINE研究是一项对韩国26家三级医院进行的前瞻性、观察性、多中心分析，研究了基于动态心电图的变量（包括HRT和TWA）对1116例急性MI或HF患者（年龄60.8±2.9岁；76.3%为男性）的预后影响。所有参与者在住院后6.8±16.5天内进行了24小时动态心电图记录。主要复合结局包括心源性死亡、室性快速心律失常和HFH。

结果

在4.3±1.2年的随访期间，HRT受损对复合结局（调整后危险比[aHR]3.41，95%置信区间[CI]2.27-5.13）或个体事件显示出最强的预测价值：心源性死亡（aHR 4.08，95%CI 2.17-7.70）、室性快速心律失常（aHR 3.72，95%CI 1.29-10.77）和HFH（aHR 4.32，95%CI 2.25-8.28）。异常HRT的预测能力在MI和HF亚组中或不同EF程度中始终保持显著。当与EF降低（<50%）相结合时，预测能力进一步增强。然而，异常TWA仅与复合结局显著相关（aHR 1.51，95%CI 1.06-2.16）。