Left Ventricular Dilatation Increases the Risk of Ventricular Arrhythmias in Patients With Reduced Systolic Function.
Left Ventricular Dilatation Increases the Risk of Ventricular Arrhythmias in Patients With Reduced Systolic Function.
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DOI：
10.1161/jaha.114.001566
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发表时间：
2015-07-31
影响因子：
5.4
通讯作者：
London B
中科院分区：
文献类型：
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作者：
Aleong RG;Mulvahill MJ;Halder I;Carlson NE;Singh M;Bloom HL;Dudley SC;Ellinor PT;Shalaby A;Weiss R;Gutmann R;Sauer WH;Narayanan K;Chugh SS;Saba S;London B
左心室（LV）射血分数降低会增加室性心律失常的风险;然而，LV射血分数预测室性心律失常的敏感性较低。LV扩张和质量可能有助于进一步对室性心律失常进行风险分层。除颤器事件遗传风险评估（GRADE）研究（N =930）中的患者，一项使用除颤器的心力衰竭受试者研究，根据LV直径和质量评估了适当的植入式心律转复除颤器休克和死亡、心脏移植或心室辅助装置放置。左室质量分为正常、轻度、中度和重度。左室舒张末期内径严重者无休克生存率低于左室舒张末期内径正常者和轻度者（P值分别为0.0002和0.0063; 2年无休克，重度74%，中度80%，轻度91%，正常88%; 4年无休克，重度62%，中度69%，轻度72%，正常81%）并且无死亡、移植，或心室辅助装置与正常和中度LV舒张末期直径相比（P分别<0.0001和0.0441; 2年生存率：重度78%，中度85%，轻度82%，正常89%; 4年生存率：重度55%，中度64%，轻度63%，正常74%）。重度左室质量比正常和轻度左室质量的无休克生存率差（分别为P =0.0370和0.0280; 2年无休克：重度80%，中度81%，轻度91%，正常87%; 4年无休克：重度68%，中度73%，轻度76%，正常76%），但与死亡、移植或心室辅助装置无关（P =0.1319）。在校正左心室射血分数的多变量考克斯比例风险分析中，左心室舒张末期直径与适当的植入式心律转复除颤器电击相关（风险比1.22，P =0.020）。左室舒张末期内径与死亡、移植或心室辅助装置的时间相关（风险比1.29，P =0.0009）。左室扩张可以补充射血分数预测室性心律失常。URL：https://www.clinicaltrials.gov。唯一标识符：NCT 02045043。
Reduced left ventricular (LV) ejection fraction increases the risk of ventricular arrhythmias; however, LV ejection fraction has a low sensitivity to predict ventricular arrhythmias. LV dilatation and mass may be useful to further risk-stratify for ventricular arrhythmias. Patients from the Genetic Risk of Assessment of Defibrillator Events (GRADE) study (N =930), a study of heart failure subjects with defibrillators, were assessed for appropriate implantable cardioverter-defibrillator shock and death, heart transplant, or ventricular assist device placement by LV diameter and mass. LV mass was divided into normal, mild, moderate, and severe classifications. Severe LV end-diastolic diameter had worse shock-free survival than normal and mild LV end-diastolic diameter (P =0.0002 and 0.0063, respectively; 2-year shock free, severe 74%, moderate 80%, mild 91%, normal 88%; 4-year shock free, severe 62%, moderate 69%, mild 72%, normal 81%) and freedom from death, transplant, or ventricular assist device compared with normal and moderate LV end-diastolic diameter (P<0.0001 and 0.0441, respectively; 2-year survival: severe 78%, moderate 85%, mild 82%, normal 89%; 4-year survival: severe 55%, moderate 64%, mild 63%, normal 74%). Severe LV mass had worse shock-free survival than normal and mild LV mass (P =0.0370 and 0.0280, respectively; 2-year shock free: severe 80%, moderate 81%, mild 91%, normal 87%; 4-year shock free: severe 68%, moderate 73%, mild 76%, normal 76%) but no association with death, transplant, or ventricular assist device (P =0.1319). In a multivariable Cox proportional hazards analysis adjusted for LV ejection fraction, LV end-diastolic diameter was associated with appropriate implantable cardioverter-defibrillator shocks (hazard ratio 1.22, P =0.020). LV end-diastolic diameter was associated with time to death, transplant, or ventricular assist device (hazard ratio 1.29, P =0.0009). LV dilatation may complement ejection fraction to predict ventricular arrhythmias. URL: https://www.clinicaltrials.gov. Unique identifier: NCT02045043.