Efimova Elena, Zeynalova Samira, Eifert Sandra, Dashkevich Alexey, Borger Michael Andrew, Meyer Anna L, Garbade Jens, Darma Angeliki, Bode Kerstin, Arya Arash
Department of Electrophysiology, Leipzig Heart Center, Leipzig, Germany.
Institute of Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany.
J Cardiovasc Electrophysiol. 2025 Feb;36(2):387-395. doi: 10.1111/jce.16539. Epub 2024 Dec 16.
To evaluate the predictive value of preoperative echocardiographic parameters for occurrence of VAs in patients with preexisting ICD undergoing LVAD implantation.
All consecutive patients (n = 264) with previous ICD who underwent LVAD surgery between May 2011 and December 2019 at our institution were included. The patients were predominantly male (89%) with NICM (59%) and a mean age of 59 ± 10 years. All LVADs were continuous flow device (154 HVAD, 21 HeartMate II, and 89 HeartMate 3). A total of 102 (39%) patients had VAs in the first year after LVAD implantation. We compared echocardiographic parameters in patients with and without VAs before LVAD, at 1 month and 1 year after LVAD implantation. Increased pre-LVEDD ≥ 72 mm predicted the occurrence of VAs after LVAD implantation for ICM patients (HR: 2.9, 95% confidence interval (CI): [1.3-6.6], p = 0.012), while a larger pre-RVEDD ≥ 46 mm was predictive in NICM patients (HR: 2.8, (CI): [1.4-5.9], p = 0.004). Moreover, a larger RVEDD at 1 year after LVAD was highly associated with VAs in the first year after LVAD implantation (50 ± 10 vs. 45 ± 8 mm, p = 0.001). All patients demonstrated a significant decrease in LVEDD as well as a reduction in severity of mitral and tricuspid regurgitation during 1 year after LVAD implantation, reflecting left ventricular unloading through the LVAD.
Larger left and right ventricular diameters before LVAD predict the occurrence of VAs after LVAD implantation in ICM and NICM patients. Persistent RV remodeling post-LVAD is also associated with VAs.
评估术前超声心动图参数对已植入植入式心律转复除颤器（ICD）的患者在接受左心室辅助装置（LVAD）植入时室性心律失常（VAs）发生情况的预测价值。
纳入2011年5月至2019年12月在我院连续接受LVAD手术且之前已植入ICD的所有患者（n = 264例）。患者以男性为主（89%），患有非缺血性心肌病（NICM）的占59%，平均年龄为59±10岁。所有LVAD均为连续流装置（154例HeartWare心室辅助装置（HVAD）、21例HeartMate II和89例HeartMate 3）。共有102例（39%）患者在LVAD植入后的第一年发生VAs。我们比较了LVAD植入前、植入后1个月和1年时发生和未发生VAs患者的超声心动图参数。对于缺血性心肌病（ICM）患者，术前左心室舒张末期内径（LVEDD）增加≥72 mm可预测LVAD植入后VAs的发生（风险比（HR）：2.9，95%置信区间（CI）：[1.3 - 6.6]，p = 0.012），而对于NICM患者，术前右心室舒张末期内径（RVEDD）≥46 mm具有预测价值（HR：2.8，（CI）：[1.4 - 5.9]，p = 0.004）。此外，LVAD植入后1年时较大的RVEDD与LVAD植入后第一年的VAs高度相关（50±10 vs. 45±8 mm，p = 0.001）。所有患者在LVAD植入后的1年中LVEDD均显著减小，二尖瓣和三尖瓣反流的严重程度也降低，这反映了通过LVAD实现的左心室减负。
LVAD植入前较大的左右心室直径可预测ICM和NICM患者LVAD植入后VAs的发生。LVAD植入后右心室持续重塑也与VAs相关。
