Right Ventricular Dysfunction and Long-Term Risk of Sudden Cardiac Death in Patients With and Without Severe Left Ventricular Dysfunction
Right Ventricular Dysfunction and Long-Term Risk of Sudden Cardiac Death in Patients With and Without Severe Left Ventricular Dysfunction
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DOI：
10.1161/circep.117.006091
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发表时间：
2018-06-01
影响因子：
8.4
通讯作者：
McLeod, Christopher J.
中科院分区：
文献类型：
--
作者：
Naksuk, Niyada;Tan, Nicholas;McLeod, Christopher J.
背景：右室收缩功能障碍常与各种心肺疾病并存。然而，RVD和心源性猝死（SCD）风险之间的关系尚未得到充分研究。本研究探讨了与RVD异质性潜在的心脏疾病患者的SCD的风险：马约诊所心脏监护室数据库包括5463例连续完整的超声心动图评价，以评估右心室收缩功能和RVD的严重程度。对所有患者进行前瞻性监测随访。结果：轻度RVD和中重度RVD的患病率分别为14.9%和17.1%。与右心室收缩功能正常的患者相比，RVD患者更可能有充血性心力衰竭、心脏骤停、肺部疾病和基线左心室射血分数较低的病史。在14个月的中位随访期间，中重度RVD患者的SCD发生率最高（7.4% vs 4.4%，轻度RVD vs 1.6%，右心室功能正常; P 35%，无或有预先存在的植入式心律转复除颤器（校正风险比，4.12; P=0.003和校正风险比，5.04; P
BACKGROUND: Right ventricular systolic dysfunction (RVD) often coexists with various cardiopulmonary diseases. However, the association between RVD and risk of sudden cardiac death (SCD) has not been well studied. This study examined the risk of SCD associated with RVD in patients with heterogeneous underlying cardiac diseases.METHODS: The Mayo Clinic cardiac care unit database included 5463 consecutive patients with complete echocardiographic evaluation to assess right ventricular systolic function and RVD severity. Prospective surveillance follow-up was obtained for all patients. SCD was adjudicated when a malignant ventricular arrhythmia was documented as the primary rhythm leading to death.RESULTS: The prevalence of mild RVD and moderate-severe RVD was 14.9% and 17.1%, respectively. Patients with RVD were more likely to have a history of congestive heart failure, cardiac arrest, pulmonary disease, and lower baseline left ventricular ejection fraction compared with those with normal right ventricular systolic function. During a median follow-up of 14 months, the incidence of SCD was highest in patients with moderate-severe RVD (7.4% versus 4.4% in mild RVD versus 1.6% in normal right ventricular function; P35% without or with preexisting implantable cardioverter-defibrillator (adjusted hazard ratio, 4.12; P=0.003 and adjusted hazard ratio, 5.04; P