Ventricular Ectopy as a Predictor of Heart Failure and Death
Ventricular Ectopy as a Predictor of Heart Failure and Death
复制标题
DOI：
10.1016/j.jacc.2015.04.062
复制
发表时间：
2015-07-14
影响因子：
24
通讯作者：
Marcus, Gregory M.
中科院分区：
文献类型：
--
作者：
Dukes, Jonathan W.;Dewland, Thomas A.;Marcus, Gregory M.
背景：对接受导管消融术患者的研究表明，室性早搏（PVC）是充血性心力衰竭（CHF）的一个可改变的风险因素。在一般人群中，PVC频率、CHF事件和死亡率之间的关系仍然未知。结论本研究的目的是确定使用24小时动态霍尔特监测仪确定的PVC频率是否是基于人群队列中左心室射血分数（LVEF）、CHF事件和死亡降低的预测因子。139例心血管健康研究（CHS）受试者，随机分配至24小时动态心电图（霍尔特）监测组，LVEF正常且无CHF病史。使用霍尔特研究定量PVC频率，并从基线和5年超声心动图测量LVEF。参与者随访CHF事件和死亡。结果PVC频率上四分位数与最低四分位数相比，LVEF 5年下降的多变量调整后的几率高3倍（比值比[OR]：3.10; 95%置信区间[CI]：1.42 - 6.77; p = 0.005），CHF发生风险增加48%（HR：1.48; 95%CI：1.08至2.04; p = 0.02），死亡风险增加31%（HR：1.31; 95%CI：1.06至1.63; p = 0.01）。对于作为连续变量分析的PVC，观察到相似的统计学显著性结果。当PVC包括至少0.7%的室性搏动时，CHF 15年风险的特异性超过90%。人群水平的风险事件CHF归因于PVC为8.1%（95%CI：1.2%至14.9%）。结论在一个基于人群的样本中，更高频率的PVC与LVEF下降，事件CHF增加，死亡率增加。由于能够通过药物或消融治疗预防PVC，PVC可能是CHF和死亡的可改变风险因素。(C)2015年美国心脏病学院基金会。
BACKGROUND Studies of patients presenting for catheter ablation suggest that premature ventricular contractions (PVCs) are a modifiable risk factor for congestive heart failure (CHF). The relationship among PVC frequency, incident CHF, and mortality in the general population remains unknown.OBJECTIVES The goal of this study was to determine whether PVC frequency ascertained using a 24-h Holter monitor is a predictor of a decrease in the left ventricular ejection fraction (LVEF), incident CHF, and death in a population-based cohort.METHODS We studied 1,139 Cardiovascular Health Study (CHS) participants who were randomly assigned to 24-h ambulatory electrocardiography (Holter) monitoring and who had a normal LVEF and no history of CHF. PVC frequency was quantified using Holter studies, and LVEF was measured from baseline and 5-year echocardiograms. Participants were followed for incident CHF and death.RESULTS Those in the upper quartile versus the lowest quartile of PVC frequency had a multivariable-adjusted, 3-fold greater odds of a 5-year decrease in LVEF (odds ratio [OR]: 3.10; 95% confidence interval [CI]: 1.42 to 6.77; p = 0.005), a 48% increased risk of incident CHF (HR: 1.48; 95% CI: 1.08 to 2.04; p = 0.02), and a 31% increased risk of death (HR: 1.31; 95% CI: 1.06 to 1.63; p = 0.01) during a median follow-up of >13 years. Similar statistically significant results were observed for PVCs analyzed as a continuous variable. The specificity for the 15-year risk of CHF exceeded 90% when PVCs included at least 0.7% of ventricular beats. The population-level risk for incident CHF attributed to PVCs was 8.1% (95% CI: 1.2% to 14.9%).CONCLUSIONS In a population-based sample, a higher frequency of PVCs was associated with a decrease in LVEF, an increase in incident CHF, and increased mortality. Because of the capacity to prevent PVCs through medical or ablation therapy, PVCs may represent a modifiable risk factor for CHF and death. (C) 2015 by the American College of Cardiology Foundation.