Beat-to-beat repolarization lability identifies patients at risk for sudden cardiac death
Beat-to-beat repolarization lability identifies patients at risk for sudden cardiac death
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DOI：
10.1111/j.1540-8167.1998.tb00130.x
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发表时间：
1998-09-01
影响因子：
2.7
通讯作者：
Berger, RD
中科院分区：
文献类型：
--
作者：
Atiga, WL;Calkins, H;Berger, RD
引言：最近的研究表明复极不稳定性与恶性室性心律失常的发生有关。然而，很少有数据存在的时间QT间期变异性的评估和它的关系，emmogenesis，我们测试的能力，QT变异指数（QTVI），一个衡量跳动的QT间期波动测量一个单一的心电图导联，以确定病人提出恶性室性心律失常，并预测其随后的发生。方法和结果：我们测量了95名接受电生理检查（EPS）的患者的QTVI。将QTVI在就诊时和23.7 +/- 14.3个月随访期间识别心源性猝死（SCD）或持续性单形性室性心动过速（MVT）患者的能力与空间QT离散度、心房起搏期间T波电交替比、FPS时MVT诱导、信号平均EGG、心率变异性和射血分数进行比较。心脏病组QTVI高于对照组（-0.7 +/-0.7 vs -1.1 +/-0.5，P < 0.05），SCD组QTVI高于其他心脏病组（0.0 +/-0.6 vs -0.8 +/-0.5，P < 0.05）。QTVI是唯一的临床变量，确定患者的SCD（P = 0.004，比值比= 12.5）逐步，逻辑多元回归。14例患者在随访期间发生了腹泻事件。Kaplan-Meier分析显示，QTVI ≥ 0.1者发生心血管事件的危险性增加（P < 0.05）。结论：（1）时间复极不稳定性的无创性测量可鉴别SCD患者，并预测无心血管事件的生存率。(2)需要进一步的研究来确定介导心跳间QT间期变异性的机制。
Introduction: Recent studies have implicated repolarization lability in the genesis of malignant ventricular arrhythmias. However, few data exist on assessment of temporal QT interval variability and its relation to arrhythmogenesis, We tested the ability of the QT variability index (QTVI), a measure of beat-to-beat QT interval fluctuations measured on a single ECG lead, to identify patients presenting with malignant ventricular arrhythmias and predict their subsequent occurrences.Methods and Results: We measured the QTVI in 95 patients presenting for electrophysiologic study (EPS). The ability of the QTVI to identify patients with sudden cardiac death (SCD) or sustained monomorphic ventricular tachycardia (MVT) on presentation and during follow-up of 23.7 +/- 14.3 months was compared with spatial QT dispersion, T wave alternans ratio during atrial pacing, MVT inducibility at FPS, signal-averaged EGG, heart rate variability, and ejection fraction. The QTVI was higher in patients with heart disease than in controls (-0.7 +/- 0.7 vs -1.1 +/- 0.5, P < 0.05), and higher in patients presenting with SCD than in other patients with heart disease (0.0 +/- 0.6 vs -0.8 +/- 0.5, P < 0.05). The QTVI was the only clinical variable that identified patients who presented with SCD (P = 0.004, odds ratio = 12.5) on stepwise, logistic multiple regression. Fourteen patients had arrhythmic events during follow-up. In a Kaplan-Meier analysis of arrhythmic events, QTVI greater than or equal to 0.1 was a discriminator for higher risk of arrhythmic events (P < 0.05).Conclusions: (1) This noninvasive measure of temporal repolarization lability identified patients with SCD and predicted arrhythmia-free survival. (2) Further studies are needed to determine the mechanisms that mediate beat-to-beat QT interval variability.