Prognostic value of pacing-induced mechanical alternans in patients with mild-to-moderate idiopathic dilated cardiomyopathy in sinus rhythm
Prognostic value of pacing-induced mechanical alternans in patients with mild-to-moderate idiopathic dilated cardiomyopathy in sinus rhythm
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DOI：
10.1016/j.jacc.2005.10.069
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发表时间：
2006-04-04
影响因子：
24
通讯作者：
Yokota, M
中科院分区：
文献类型：
--
作者：
Hirashiki, A;Izawa, H;Yokota, M
目的 前瞻性研究窦性心律的轻至中度特发性扩张型心肌病 (IDCM) 患者中起搏引起的机械交替发生与预后之间的关系。背景技术部分严重心力衰竭患者会出现机械交替，但IDCM患者机械交替的发生与预后之间的关系尚不清楚。方法测量心房起搏时的左心室压力，并采集36例IDCM患者和8例对照者的左心室心内膜心肌活检标本。将特发性扩张型心肌病患者分为两组，其中 22 名未发生心率高达 140 次/分钟的机械交替的个体（A 组）和 14 名发生机械交替的个体（B 组）。平均随访3.7年。结果A、B组左心室射血分数、血浆脑钠肽浓度无显着性差异。A、B组心肌中兰尼碱受体2信使核糖核酸（mRNA）丰度显着低于对照组，而B组肌浆网Ca2+-ATPase mRNA丰度显着低于A组或对照组。逐步多变量分析确定起搏引起的机械交替是心脏事件的最强预测因子。 A 组的无事件生存率显着高于 B 组。 结论 起搏引起的机械交替的发生是窦性心律的轻至中度 IDCM 患者预后不良的潜在有用指标。
OBJECTIVES The relation between the occurrence of pacing-induced mechanical alternans and prognosis in patients with mild-to-moderate idiopathic dilated cardiomyopathy (IDCM) in sinus rhythm was investigated prospectively. The myocardial expression of genes for Ca2+-handling proteins in such patients was also examined.BACKGROUND Mechanical alternans occurs in some patients with severe heart failure, but the relation between the occurrence of mechanical alternans and prognosis in patients with IDCM has remained unknown.METHODS Left ventricular (LV) pressure was measured during atrial pacing, and LV endomyocardial biopsy specimens were collected in 36 IDCM patients and 8 controls. Idiopathic dilated cardiomyopathy patients were divided into two groups consisting of 22 individuals who did not develop mechanical alternans at heart rates up to 140 beats/min (group A) and of 14 individuals who did (group B). The patients were followed up for a mean of 3.7 years.RESULTS There was no significant difference in LV ejection fraction or the plasma concentration of brain natriuretic peptide between groups A and B. The myocardial abundance of ryanodine receptor 2 messenger ribonucleic acid (mRNA) was significantly lower in groups A and B than in controls, whereas that of sarcoplasmic reticulum Ca2+-ATPase mRNA was significantly lower in group B than in group A or controls. Stepwise multivariate analysis identified pacing-induced mechanical alternans as the strongest predictor of cardiac events. Event-free survival in group A was significantly greater than that in group B.CONCLUSIONS The occurrence of pacing-induced mechanical alternans is a potentially useful indicator of poor prognosis in patients with mild-to-moderate IDCM in sinus rhythm.