Non-invasive Risk Stratification in Pediatric Ventricular Pre-excitation.
Non-invasive Risk Stratification in Pediatric Ventricular Pre-excitation.
复制标题
小儿心室预激的无创风险分层。
DOI：
10.1007/s00246-020-02285-3
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发表时间：
2020
影响因子：
1.6
通讯作者：
Webster,Gregory
中科院分区：
文献类型：
--
作者：
Khaznadar,Rana;Chandler,StephanieF;Chaouki,ASami;Tsao,Sabrina;Webster,Gregory
心室预激儿童有猝死的危险。这项回顾性儿科研究确定了接受过电生理学研究（EPS）的> 8岁患者。我们的主要目的是确定非侵入性风险分层的性能特征。受试者分为两组。第1组无症状或有非特异性症状（心悸、胸痛和轻度头痛），无记录的室上性心动过速（SVT）。第2组有晕厥、记录的SVT或危及生命的事件。作为次要目的，我们测试了症状严重的患者从诊断日期到侵入性风险分层日期的时间是否更短。在平均年龄为14.2岁的93例患者中，25例患者记录了SVT，6例患者发生了晕厥，1例患者发生了危及生命的事件。非侵入性危险分层的敏感性为7%。特异性为91%。阳性预测值为14%，阴性预测值为84%。即使有严重症状的患者在EPS前也通常进行非侵入性风险分层，尽管发生率较低（第1组，98%;第2组84%，p = 0.02）。至EPS的中位时间为4.2个月（第1组）和4.5个月（第2组，p= 0.63）。非侵入性危险分层是侵入性危险分层的不良预测因子。心脏病专家应告知家属无创风险分层的局限性，并考虑从有创风险分层和可能的消融术开始。与直觉相反，严重的症状与电生理检查的时间较短无关。
Children with ventricular pre-excitation are at risk for sudden death. This retrospective pediatric study identified patients > 8 years of age who had undergone electrophysiology study (EPS). Our primary objective was to determine the performance characteristics of non-invasive risk stratification. Subjects were separated into two groups. Group 1 was asymptomatic or had non-specific symptoms (palpitations, chest pain, and light headedness) without documented supraventricular tachycardia (SVT). Group 2 had syncope, documented SVT, or a life-threatening event. As a secondary aim, we tested whether patients with severe symptoms had a shorter time from the date of diagnosis to the date of invasive risk stratification. Among 93 patients with an average age of 14.2 years, 25 patients had documented SVT, 6 had syncope, and 1 had a life-threatening event. The sensitivity of non-invasive risk stratification was 7%. The specificity was 91%. The positive predictive valve was 14% and the negative predictive value was 84%. Even patients with severe symptoms commonly underwent non-invasive risk stratification prior to EPS, albeit at a lower rate (Group 1, 98%; Group 2 84%,p= 0.02). The median time to EPS was 4.2 months (Group 1) and 4.5 months (Group 2,p= 0.63). Non-invasive risk stratification was a poor predictor of invasive risk stratification. Cardiologists should counsel families about the limitations of non-invasive risk stratification and consider starting with invasive risk stratification and possible ablation. Counterintuitively, severe symptoms were not associated with a shorter time to electrophysiology study.