Noninvasive arrhythmia risk stratification in idiopathic dilated cardiomyopathy -: Results of the Marburg cardiomyopathy study
Noninvasive arrhythmia risk stratification in idiopathic dilated cardiomyopathy -: Results of the Marburg cardiomyopathy study
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DOI：
10.1161/01.cir.0000100721.52503.85
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发表时间：
2003-12-09
期刊：
影响因子：
37.8
通讯作者：
Maisch, B
中科院分区：
文献类型：
--
作者：
Grimm, W;Christ, M;Maisch, B
背景：在特发性扩张型心肌病（IDC）中，关于预防性植入式心律转复除颤器治疗的心律失常风险分层是一个完全未解决的问题。方法与结果：对343例IDC患者进行前瞻性心律失常风险分层，包括超声心动图左室射血分数和大小、信号平均心电图、动态心电图心律失常、QTc离散度、心率变异性、气压反射敏感性和微伏t波交替分析。在52+/-21个月的随访期间，46例（13%）患者发生了主要心律失常事件，定义为持续性室性心动过速、心室颤动或猝死。在多变量分析中，左室射血分数是窦性心律失常患者唯一显著的心律失常风险预测指标，射血分数每降低10%，相对风险为2.3 （95% CI， 1.5至3.3;P = 0.0001）。霍尔特非持续性室性心动过速与心律失常风险增加的趋势相关（RR, 1.7; 95% CI, 0.9 - 3.3; P = 0.11），而受体阻滞剂治疗与心律失常风险降低的趋势相关（RR, 0.6; 95% CI, 0.3 - 1.2; P = 0.13）。在房颤患者中，多变量Cox分析也发现左室射血分数和缺乏受体阻滞剂治疗是唯一重要的心律失常风险预测因素。结论：左室射血分数降低和未使用β -受体阻滞剂是IDC患者重要的心律失常风险预测指标，而信号平均心电图、压反射敏感性、心率变异性和t波交替似乎对心律失常风险分层没有帮助。这些发现对未来评估IDC预防性植入式心律转复除颤器治疗的研究设计具有重要意义。
Background-Arrhythmia risk stratification with regard to prophylactic implantable cardioverter-defibrillator therapy is a completely unsolved issue in idiopathic dilated cardiomyopathy (IDC).Methods and Results-Arrhythmia risk stratification was performed prospectively in 343 patients with IDC, including analysis of left ventricular (LV) ejection fraction and size by echocardiography, signal-averaged ECG, arrhythmias on Holter ECG, QTc dispersion, heart rate variability, baroreflex sensitivity, and microvolt T-wave alternans. During 52+/-21 months of follow-up, major arrhythmic events, defined as sustained ventricular tachycardia, ventricular fibrillation, or sudden death, occurred in 46 patients (13%). On multivariate analysis, LV ejection fraction was the only significant arrhythmia risk predictor in patients with sinus rhythm, with a relative risk of 2.3 per 10% decrease of ejection fraction (95% CI, 1.5 to 3.3; P = 0.0001). Nonsustained ventricular tachycardia on Holter was associated with a trend toward higher arrhythmia risk (RR, 1.7; 95% CI, 0.9 to 3.3; P = 0.11), whereas beta-blocker therapy was associated with a trend toward lower arrhythmia risk (RR, 0.6; 95% CI, 0.3 to 1.2; P = 0.13). In patients with atrial fibrillation, multivariate Cox analysis also identified LV ejection fraction and absence of beta-blocker therapy as the only significant arrhythmia risk predictors.Conclusions-Reduced LV ejection fraction and lack of beta-blocker use are important arrhythmia risk predictors in IDC, whereas signal-averaged ECG, baroreflex sensitivity, heart rate variability, and T-wave alternans do not seem to be helpful for arrhythmia risk stratification. These findings have important implications for the design of future studies evaluating prophylactic implantable cardioverter-defibrillator therapy in IDC.