Microvolt T wave alternans in adults with congenital heart diseases characterized by right ventricle pathology or single ventricle physiology: a case control study.
Microvolt T wave alternans in adults with congenital heart diseases characterized by right ventricle pathology or single ventricle physiology: a case control study.
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DOI：
10.1186/1471-2261-13-26
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发表时间：
2013-04-03
影响因子：
2.1
通讯作者：
Grajek S
中科院分区：
文献类型：
--
作者：
Cieplucha A;Trojnarska O;Bartczak A;Kramer L;Grajek S
在成人先天性心脏病（CHD）患者中，评估心源性猝死（SCD）的风险仍然是一个巨大的挑战。虽然微伏t波交替已被纳入SCD风险分层算法，但其在成人冠心病患者中的作用仍有待研究。我们试图确定MTWA在这一特定组中的发生率及其与室性心律失常（VA）和其他可能与SCD相关的临床表现的一致性。本研究将102例以右心室病理或单心室生理特征（TGA、UVH、Ebstein 's异常、ccTGA、Eisenmenger综合征、DORV、CAT、未手术ToF）为特征的冠心病患者与45例年龄和性别匹配的对照组进行比较。所有受试者均行MTWA谱测试、动态心电图监测、心肺测试、BNP评估。在排除技术上不充分的痕迹后，剩余的MTWA结果被分类为阳性（+），阴性（−）和不确定（ind）。由于预后意义相似，MTWA（+）和（ind）合并为“异常”组。与对照组相比，研究组的MTWA异常发生率更高（39.2% vs 2.3%, p = 0.00001）。持续性室性心动过速（sVT）在MTWA异常组中比MTWA异常组更常见（-）：19.4% vs 3.6%, p = 0.026。MTWA异常患者血饱和度较低（p = 0.047），男性居多（p = 0.031）， NYHA分级较高（p = 0.04），心肺指标较差：%PeakVO2 （p = 0.034）、%HRmax （p = 0.003）。多因素线性回归分析证实增加MTWA异常概率的因素为：sVT （OR = 20.7, p = 0.037）和男性性别（OR = 15.9, p = 0.001）；在单变量分析:男性(或= 2.7,p = 0.021),弗吉尼亚州的存在(或= 2.6,p = 0.049), NYHA >我(或= 2.06,p = 0.033), % HRmax(或= 0.94,p = 0.005), % PeakVO2(或= 0.97,p = 0.042), VE / VCO2slope(或= 1.05,p = 0.037)。MTWA异常在患有冠心病的成年人中比健康人更常见。恶性VA患者、男性以及心力衰竭和发绀患者中MTWA异常的概率增加。MTWA可能在冠心病成人SCD的危险分层中发挥潜在作用。
Among adults with congenital heart diseases (CHD) evaluation of sudden cardiac death (SCD) risk remains a great challenge. Although microvolt T-wave alternans has been incorporated into SCD risk stratification algorithm, its role in adults with CHD still requires investigation. We sought to determine the incidence of MTWA in this specific group and its coincidence with ventricular arrhythmia (VA) and other clinical findings presumably associated with SCD. A case–control study was performed in which 102 patients with CHD characterized by right ventricle pathology or single ventricle physiology (TGA, UVH, Ebstein’s anomaly, ccTGA, Eisenmenger syndrome, DORV, CAT, unoperated ToF) were compared to 45 age- and sex-matched controls. All subjects underwent spectral MTWA test, ambulatory ecg monitoring, cardiopulmonary test, BNP assessment. After excluding technically inadequate traces, the remaining MTWA results were classified as positive(+), negative(−) and indeterminate(ind). Due to similar prognostic significance MTWA(+) and (ind) were combined into a common group labeled ‘abnormal’. Abnormal MTWA was present more often in the study group, compared to controls (39.2% vs 2.3%, p = 0.00001). Sustained ventricular tachycardia (sVT) was observed more often among subjects with abnormal MTWA compared to MTWA(−): 19.4% vs 3.6%, p = 0.026. The patients with abnormal MTWA had a lower blood saturation (p = 0.047), more often were males (p = 0.031), had higher NYHA class (p = 0.04), worse cardiopulmonary parameters: %PeakVO2 (p = 0.034), %HRmax (p = 0.003). Factors proven to increase probability of abnormal MTWA on multivariate linear regression analysis were: sVT (OR = 20.7, p = 0.037) and male gender (OR = 15.9, p = 0.001); on univariate analysis: male gender (OR = 2.7, p = 0.021), presence of VA (OR = 2.6, p = 0.049), NYHA > I (OR = 2.06, p = 0.033), %HRmax (OR = 0.94, p = 0.005), %PeakVO2 (OR = 0.97, p = 0.042), VE/VCO2slope (OR = 1.05, p = 0.037). Abnormal MTWA occurs significantly more often in adults with the chosen forms of CHD than among healthy subjects. The probability of abnormal MTWA increases in patients with malignant VA, in males and among subjects with heart failure and cyanosis. MTWA might be of potential role in risk stratification for SCD in adults with CHD.
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37.8
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