Left ventricle remodeling predicts the recurrence of ventricular tachyarrhythmias in implantable cardioverter defibrillator recipients for secondary prevention
Left ventricle remodeling predicts the recurrence of ventricular tachyarrhythmias in implantable cardioverter defibrillator recipients for secondary prevention
复制标题
DOI：
10.1186/s12872-016-0416-y
复制
发表时间：
2016-11-21
影响因子：
2.1
通讯作者：
Chen, Mien-Cheng
中科院分区：
文献类型：
--
作者：
Lee, Wei-Chieh;Chen, Huang-Chung;Chen, Mien-Cheng
背景资料：植入式心律转复除颤器（ICD）是室性心动过速/室颤（VT/VF）二级预防的有效治疗方法。在植入ICD之前和随着时间的推移，可能会发生左心室（LV）重塑。然而，目前尚不清楚如何左心室重塑影响随后的风险复发VT/VF在ICD recipients under optimal medical therapeutic.Methods：从2004年5月至2015年6月，144例患者接受ICD植入二级预防入组本研究。所有的信息询问从ICD设备在随访或ICD治疗史（抗心动过速起搏和休克治疗）进行了审查和验证VT/VF.Results的发生率：在平均随访1110.5 +/- 860.6天，53例（36.8%）有VT/VF发作复发和91例患者没有复发的VT/VF发作后ICD植入。左心室舒张末期容积（LVEDV）> 163.5 mL对VT/VF复发具有显著的预测价值（曲线下面积：0.602，p = 0.041）。此外，复发性VT/VF患者中LVEDV > 163.5 mL的患者百分比显著高于无复发性VT/VF患者（62.3 vs 40.0%，p = 0.010）。单变量考克斯回归分析显示，左心室射血分数163.5 mL（p = 0.012）和QRS宽度> 125 msec（p = 0.049）是VT/VF复发的显著预测因素。然而，只有LVEDV > 163.5 mL（风险比：2.549，95%置信区间：1.249与5.201相似，p = 0.010）和QRS宽度> 125 msec（风险比：2.173，95%置信区间：1.030与4.586相似，p = 0.042）是多变量调整后VT/VF复发的独立预测因素。在接受最佳药物治疗的二级预防ICD患者中，LV重构和QRS宽度> 125 msec是VT/VF复发的独立预测因素，与LV射血分数无关。
Background: Implantable cardioverter defibrillator (ICD) is an effective treatment for secondary prevention of ventricular tachycardia/ventricular fibrillation (VT/VF). Left ventricular (LV) remodeling may develop before ICD implant and over time. However, it remains unclear how LV remodeling affects subsequent risk for recurrence VT/VF in ICD recipients under optimal medical therapy.Methods: From May of 2004 to June of 2015, 144 patients received ICD implantation for secondary prevention were enrolled in this study. All information interrogated from ICD devices during follow-up or ICD therapy history (antitachycardia pacing and shock therapy) were reviewed and validated the occurrences of VT/VF.Results: At a mean follow-up of 1110.5 +/- 860.6 days, 53 patients (36.8%) had recurrence of VT/VF episodes and 91 patients had no recurrence of VT/VF episode after ICD implant. Left ventricular end-diastolic volume (LVEDV) > 163.5 mL had significant predictive value for VT/VF recurrence (area under the curve: 0.602, p = 0.041). Moreover, the percentage of patients with LVEDV > 163.5 mL was significantly higher in patients with recurrent VT/VF than patients without recurrent VT/VF (62.3 vs 40.0%, p = 0.010). Left ventricular ejection fraction 163.5 mL (p = 0.012) and QRS width > 125 msec (p = 0.049) were significant predictors for VT/VF recurrence by univariate Cox regression analysis. However, only LVEDV > 163.5 mL (hazard ratio: 2.549, 95% confidence interval: 1.249 similar to 5.201, p = 0.010) and QRS width > 125 msec (hazard ratio: 2.173, 95% confidence interval: 1.030 similar to 4.586, p = 0.042) were independent predictors for recurrence of VT/VF after multivariable adjustment.Conclusion: LV remodeling and QRS width > 125 msec were independent predictors for VT/VF recurrence in secondary prevention ICD recipients under optimal medical therapy, independent of LV ejection fraction.