Noji S, Kitamura M, Shibuya M, Uwabe K, Otsuka G, Aomi S, Hachida M, Endo M, Hashimoto A, Koyanagi H
Department of Cardiovascular Surgery, Heart Institute of Japan, Tokyo Women's Medical College.
Nihon Kyobu Geka Gakkai Zasshi. 1995 Mar;43(3):313-7.
Sudden death is a well known complication of aortic valve regurgitation and remains a common cause of late mortality after aortic valve replacement. Although malignant arrhythmias have been suggested as the cause of these outcome, there has been little information concerning the frequency and severity of ventricular arrhythmias in patients with aortic valve regurgitation. In order to evaluate the relation between the severity and/or frequency of ventricular arrhythmias and late postoperative results in patients with pure aortic valve regurgitation, 24-hour ambulatory electrocardiographic recordings were obtained before surgery in 107 patients without coronary artery disease. Grading of ventricular arrhythmias was based on a Lown method and compared with hemodynamic data. Ventricular premature beats were observed in 101 patients (94.4%) before operation. Multiformity was found in 10 patients (9.3%) couplets in 19 patients (17.8%) and ventricular tachycardia in 32 patients (29.9%). Patients with severe ventricular arrhythmias (Lown grade 3 or 4: 57.0%) had a higher left ventricular end systolic volume index (LVESVI) 153.1 +/- 76.4 ml/m2 vs 96.5 +/- 35.0 ml/m2 (p = 0.0001); a higher left ventricular end diastolic volume index (LVEDVI) 257.0 +/- 85.4 ml/m2 vs 206.5 +/- 58.3 ml/m2 (p = 0.0009); a lower left ventricular ejection fraction (LVEF) 43.4 +/- 12.5% vs 54.2 +/- 9.8% (p = 0.0001). LVESVI was not related to the severity of ventricular arrhythmias, but was significantly related to the frequency (p < 0.05). All patients with late death were belonging to Lown grade 3 or 4 in severity and more than 30 beats per hour in frequency (28.6%). This study indicates that ventricular arrhythmias are common in patients with aortic valve regurgitation.(ABSTRACT TRUNCATED AT 250 WORDS)
猝死是主动脉瓣反流的一种众所周知的并发症，并且仍然是主动脉瓣置换术后晚期死亡的常见原因。尽管恶性心律失常被认为是这些不良后果的原因，但关于主动脉瓣反流患者室性心律失常的发生率和严重程度的信息却很少。为了评估单纯主动脉瓣反流患者室性心律失常的严重程度和/或发生率与术后晚期结果之间的关系，对107例无冠状动脉疾病的患者在手术前进行了24小时动态心电图记录。室性心律失常的分级基于洛恩方法，并与血流动力学数据进行比较。术前101例患者（94.4%）观察到室性早搏。10例患者（9.3%）出现多形性，19例患者（17.8%）出现成对早搏，32例患者（29.9%）出现室性心动过速。严重室性心律失常（洛恩分级3或4：57.0%）的患者左心室收缩末期容积指数（LVESVI）更高，分别为153.1±76.4 ml/m² 和96.5±35.0 ml/m²（p = 0.0001）；左心室舒张末期容积指数（LVEDVI）更高，分别为257.0±85.4 ml/m² 和206.5±58.3 ml/m²（p = 0.0009）；左心室射血分数（LVEF）更低，分别为43.4±12.5% 和54.2±9.8%（p = 0.0001）。LVESVI与室性心律失常的严重程度无关，但与发生率显著相关（p < 0.05）。所有晚期死亡患者的室性心律失常严重程度均为洛恩分级3或4，且频率超过每小时30次（28.6%）。本研究表明，室性心律失常在主动脉瓣反流患者中很常见。（摘要截短于250字）
