Impact of QRS duration and morphology on the risk of sudden cardiac death in asymptomatic patients with aortic stenosis: the SEAS (Simvastatin and Ezetimibe in Aortic Stenosis) Study.
Impact of QRS duration and morphology on the risk of sudden cardiac death in asymptomatic patients with aortic stenosis: the SEAS (Simvastatin and Ezetimibe in Aortic Stenosis) Study.
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QRS 时限和形态对无症状主动脉瓣狭窄患者心源性猝死风险的影响：SEAS（辛伐他汀和依折麦布治疗主动脉瓣狭窄）研究。
DOI：
10.1016/j.jacc.2011.12.020
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发表时间：
2012
影响因子：
24
通讯作者：
K. Wachtell
中科院分区：
文献类型：
--
作者：
A. M. Greve;E. Gerdts;K. Boman;C. Gohlke;A. Rossebø;R. Devereux;L. Køber;S. Ray;R. Willenheimer;K. Wachtell
目的探讨无症状主动脉瓣狭窄（AS）患者观察等待期间QRS持续时间和形态学的预测价值。在许多不同的人群中，qrs持续时间和形态学与预后不良有关，但对无症状AS患者的预测价值，特别是对心源性猝死（SCD）风险的预测价值尚未得到很好的研究。方法：在SEAS（辛伐他汀和依泽替米布治疗主动脉瓣狭窄）研究中，无症状AS患者随机分为辛伐他汀/依泽替米布联合治疗组和安慰剂组。通过调整临床和超声心动图协变量，评估QRS持续时间对心血管发病率和死亡率的影响，QRS持续时间作为<85 ms、85 ~ 99 ms和≥100 ms（不包括束支阻滞[BBB]）和BBB患者QRS形态的分类变量。结果1542例患者获得qrs数据，平均随访4.3±0.8年（6631患者年）。68例心血管死亡（4.6%），包括27例SCDs（1.8%）。QRS持续时间<85 ms的有900例（58.4%），85 ~ 99 ms的有396例（25.7%），≥100 ms的有144例（9.3%），有血脑屏障的有102例（6.6%）。在多变量分析中，与QRS持续时间<85 ms的患者相比，QRS持续时间≥100 ms的患者发生SCD的风险高出5倍（95%置信区间：1.8 ~ 13.7,p = 0.002），心血管死亡风险高出2.5倍（95%置信区间：1.2 ~ 5.1,p = 0.01）。结论无症状AS患者sqrs持续时间和形态学与预后不良，特别是SCD的风险独立相关。辛伐他汀依折替贝治疗主动脉瓣狭窄[SEAS]； NCT00092677)
ObjectivesThe aim of the study was to examine the predictive value of QRS duration and morphology during watchful waiting in asymptomatic patients with aortic stenosis (AS).BackgroundQRS duration and morphology are associated with poor prognosis in many different populations, but the predictive value, particularly of the risk of sudden cardiac death (SCD), in asymptomatic patients with AS has not been well studied.MethodsData were obtained in asymptomatic AS patients randomized to simvastatin/ezetimibe combination versus placebo in the SEAS (Simvastatin and Ezetimibe in Aortic Stenosis) study. The impact of QRS duration, evaluated as a categorical variable of <85 ms versus 85 to 99 ms and ≥100 ms (excluding bundle branch block [BBB]) and QRS morphology in those with BBB, on cardiovascular morbidity and mortality was assessed by adjusting for clinical and echocardiographic covariates.ResultsQRS data were available in 1,542 patients who were followed for a mean of 4.3 ± 0.8 years (6,631 patient-years of follow-up). There were 68 cardiovascular deaths (4.6%), including 27 SCDs (1.8%). QRS duration was <85 ms in 900 patients (58.4%), 85 to 99 ms in 396 (25.7%), ≥100 ms in those without BBB in 144 (9.3%), and 102 (6.6%) in those with BBB. In multivariable analyses, those with QRS duration ≥100 ms had, compared with those with QRS duration <85 ms, a 5-fold higher risk of SCD (95% confidence interval: 1.8 to 13.7, p = 0.002) and a 2.5-fold higher risk of cardiovascular death (95% confidence interval: 1.2 to 5.1, p = 0.01).ConclusionsQRS duration and morphology in asymptomatic patients with AS are independently associated with a poor prognosis, particularly the risk of SCD. (Simvastatin Ezetimibe in Aortic Stenosis [SEAS]; NCT00092677)
DOI：
10.1152/ajpheart.00684.2006
发表时间：
2007-07-01
影响因子：
4.8
作者：
Kasi, Vijaykumar S.;Xiao, Hong D.;Dudley, Samuel C., Jr.
通讯作者：
Dudley, Samuel C., Jr.