Beat-to-beat three-dimensional ECG variability predicts ventricular arrhythmia in ICD recipients.
Beat-to-beat three-dimensional ECG variability predicts ventricular arrhythmia in ICD recipients.
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DOI：
10.1016/j.hrthm.2010.08.022
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发表时间：
2010-11
期刊：
影响因子：
5.5
通讯作者：
Berger, Ronald D.
中科院分区：
文献类型：
--
作者：
Tereshchenko, Larisa G.;Han, Lichy;Cheng, Alan;Marine, Joseph E.;Spragg, David D.;Sinha, Sunil;Dalal, Darshan;Calkins, Hugh;Tomaselli, Gordon F.;Berger, Ronald D.
与QT测量相关的方法学困难促使人们寻找新的复极异质性心电图标志物。我们假设心搏间三维心电向量变异性预测结构性心脏病左心室收缩功能障碍和植入ICD患者的室性心律失常（VA）。记录了414例结构性心脏病患者[平均年龄59.4±12.0岁; 280例白人（68%）和134例黑人（32%）]在植入ICD作为心源性猝死一级预防前的静息时基线正交ECG。将30个连续窦性心搏的R和T峰绘制成三维图，形成R峰云和T峰云。峰值云的体积被计算为凸船体内的体积。对患者进行至少6个月的随访;使用适当ICD治疗的持续VA作为终点。在18.4±12.5个月的平均随访时间内，414例患者中有61例（14.73%或9.6%/人年随访）在适当ICD治疗后出现持续VA：其中41例为白人，20例为黑人。在多变量考克斯模型中，包括VA诱导和β受体阻滞剂的使用，T/R峰云体积比的最高三分位数显著预测所有患者的VA（HR 1.68 95% CI 1.01-2.80;p=0.046）。黑人的T峰云体积和T/R峰云体积比显著较小[0.09（0.04-0.15）vs. 0.11（0.06-0.22），p=0.002]。结构性心脏病和收缩功能障碍患者T峰云体积相对较大与VA风险增加相关。
Methodological difficulties associated with QT measurements prompt search for new ECG markers of repolarization heterogeneity. We hypothesized that beat-to-beat 3-dimensional vectorcardiogram variability predicts ventricular arrhythmia (VA) in patients with structural heart disease left ventricular systolic dysfunction and implanted ICD. Baseline orthogonal ECGs were recorded in 414 patients with structural heart disease [mean age 59.4±12.0; 280 whites (68%) and 134 blacks (32%)] at rest before implantation of ICD for primary prevention of sudden cardiac death. R and T peaks of 30 consecutive sinus beats were plotted in 3-D to form an R peaks cloud and a T peaks cloud. The volume of the peaks cloud was calculated as the volume within the convex hull. Patients were followed at least 6 months; sustained VA with appropriate ICD therapies served as an endpoint. During a mean follow-up time of 18.4±12.5 months, 61 of the 414 patients (14.73% or 9.6% per person-year of follow-up) experienced sustained VA with appropriate ICD therapies: 41 of them were whites and 20 were blacks. In the multivariate Cox model that included inducibility of VA and use of beta-blockers, the highest tertile of T/R peaks cloud volume ratio significantly predicted VA (HR 1.68 95% CI 1.01–2.80;p=0.046) in all patients. T peaks cloud volume and T/R peaks cloud volume ratio were significantly smaller in blacks [0.09 (0.04–0.15) vs. 0.11 (0.06–0.22), p=0.002]. Relatively large T peaks cloud volume is associated with increased risk of VA in patients with structural heart disease and systolic dysfunction.
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DOI：
10.1056/nejmoa071098
发表时间：
2008-09-04
期刊：
The New England journal of medicine
影响因子：
--
作者：
Poole JE;Johnson GW;Hellkamp AS;Anderson J;Callans DJ;Raitt MH;Reddy RK;Marchlinski FE;Yee R;Guarnieri T;Talajic M;Wilber DJ;Fishbein DP;Packer DL;Mark DB;Lee KL;Bardy GH
通讯作者：
Bardy GH
影响因子：
24
作者：
Haigney, MC;Zareba, W;Moss, AJ
通讯作者：
Moss, AJ
影响因子：
37.8
作者：
Fuller, MS;Sándor, G;Lux, RL
通讯作者：
Lux, RL
影响因子：
37.8
作者：
Russo, AM;Hafley, GE;Buxton, AE
通讯作者：
Buxton, AE
DOI：
10.1152/ajpheart.00936.2009
发表时间：
2010-05-01
影响因子：
4.8
作者：
Pueyo, Esther;Husti, Zoltan;Rodriguez, Blanca
通讯作者：
Rodriguez, Blanca