Chino M, Hara Y, Fujii I, Nakamura Y
J Cardiogr. 1981 Dec;11(4):1215-22.
Incidence and prognostic significance of repetitive ventricular premature contractions in various cardiac diseases were evaluated retrospectively with 593 consecutive patients referred for the 24-hour continuous electrocardiographic monitoring (Holter monitoring). Primary cardiac diagnoses for 308 patients with structural heart diseases included previous myocardial infarction (MI) in 151 patients, angina pectoris in 34, congestive cardiomyopathy (COCM) in 21, valvular heart disease in 29, hypertensive heart disease (HHD) in 18, conduction disturbance in 28, and other cardiovascular abnormalities in 17 patients. Other 285 patients (48%) had no known structural heart disease. Repetitive ventricular premature contractions (VPCs) was defined as the occurrence of self-terminating two (couplet), three (triplet) or more consecutive VPCs without associated hemodynamic sequelae. Holter monitoring was done with simultaneous two-channel recordings. Repetitive VPCs were seen in 96 patients; 17% of patients with MI, 52% of COCM and 7% of no structural hart disease. Among 308 patients with structural heart disease, 91 had congestive heart failure and 42% of these had repetitive VPCs, whereas only 17% of patients without congestive heart failure had repetitive VPCs. Coronary arteriographic and ventriculographic findings were reviewed in 91 patients with previous MI. Neither the degree of coronary artery involvements nor left ventricular ejection fraction had influence on the occurrence of repetitive VPCs. Four hundreds and sixty-nine patients under the age of 69 years were followed from 6 to 36 months (mean 19 months). Thirteen patients including 5 cases with MI (4% of the cases with MI), 4 with COCM (21% of COCM) and 4 with other structural heart disease (4% of other disease) died suddenly in the follow-up period. In the patients followed, 72 had repetitive VPCs and 9 of them died suddenly. These 9 patients consisted of 4 patients with MI (25% of the cases with MI having repetitive VPCs), 4 with COCM (40% of COCM) and 1 with other structural heart disease (3% of other disease). Thus, patients with MI or COCM had higher incidence of repetitive VPCs and they are at a high risk for sudden cardiac death.
我们对593例连续接受24小时动态心电图监测（Holter监测）的患者进行回顾性分析，以评估各种心脏疾病中重复性室性早搏的发生率及其预后意义。308例患有结构性心脏病的患者的主要心脏诊断包括：151例曾患心肌梗死（MI），34例患心绞痛，21例患充血性心肌病（COCM），29例患心脏瓣膜病，18例患高血压性心脏病（HHD），28例有传导障碍，17例有其他心血管异常。另外285例患者（48%）无已知的结构性心脏病。重复性室性早搏（VPCs）定义为出现自行终止的两个（成对）、三个（三联律）或更多连续的室性早搏，且无相关的血流动力学后遗症。Holter监测采用同步双导联记录。96例患者出现重复性室性早搏；MI患者中17%出现，COCM患者中52%出现，无结构性心脏病患者中7%出现。在308例患有结构性心脏病的患者中，91例有充血性心力衰竭，其中42%有重复性室性早搏，而无充血性心力衰竭的患者中只有17%有重复性室性早搏。对91例曾患心肌梗死的患者的冠状动脉造影和心室造影结果进行了回顾。冠状动脉受累程度和左心室射血分数均对重复性室性早搏的发生无影响。对469例69岁以下的患者进行了6至36个月（平均19个月）的随访。13例患者在随访期间突然死亡，其中包括5例心肌梗死患者（占心肌梗死病例的4%），4例充血性心肌病患者（占充血性心肌病的21%）和4例患有其他结构性心脏病的患者（占其他疾病的4%）。在接受随访的患者中，72例有重复性室性早搏，其中9例突然死亡。这9例患者包括4例心肌梗死患者（占患有重复性室性早搏的心肌梗死病例的25%），4例充血性心肌病患者（占充血性心肌病的40%）和1例患有其他结构性心脏病的患者（占其他疾病的3%）。因此，心肌梗死或充血性心肌病患者重复性室性早搏的发生率较高，且他们发生心脏性猝死的风险较高。
