Mechanisms linking electrical alternans and clinical ventricular arrhythmia in human heart failure
Mechanisms linking electrical alternans and clinical ventricular arrhythmia in human heart failure
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DOI：
10.1016/j.hrthm.2016.05.017
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发表时间：
2016-09-01
期刊：
影响因子：
5.5
通讯作者：
Trayanova, N. A.
中科院分区：
文献类型：
--
作者：
Bayer, J. D.;Lalani, G. G.;Trayanova, N. A.
心力衰竭（HF）患者室性心动过速（VT）和室颤（VF）的发生机制尚不明确。目的本研究的目的是通过计算机-临床方法阐明HF患者VT/VF的发生机制。方法在53例HF患者和18例对照患者中，我们建立了近静息心率心室起搏期间低幅动作电位电压交替（APV-ALT）与长期随访VT/VF之间的关系。基于人体电生理和磁共振成像数据，使用多尺度人体心室模型解剖了患者无法确定的APV-ALT向VT/VF转变的机制结果APV-ALT k-评分>1.7的患者，复杂动作电位时程（APD）振荡（>=平均APD的2.3%），而不是APD交替，在长期随访期间最准确地预测VT/VF（+82%; -90%预测值）。在失败的人类心室模型中，异常的肌浆网（SR）钙处理在550 ms的周期长度的起搏期间引起APV-ALT（>1 mV），其以更快的速率转变为大幅度（>100 ms）不一致的复极时间交替（RT-ALT）。这引发了VT/VF（周期长度
BACKGROUND Mechanisms of ventricular tachycardia (VT) and ventricular fibrillation (VF) in patients with heart failure (HF) are undefined.OBJECTIVE The purpose of this study was to elucidate VT/VF mechanisms in HF by using a computational-clinical approach.METHODS In 53 patients with HF and 18 control patients, we established the relationship between low-amplitude action potential voltage alternans (APV-ALT) during ventricular pacing at near-resting heart rates and VT/VF on long-term follow-up. Mechanisms underlying the transition of APV-ALT to VT/VF, which cannot be ascertained in patients, were dissected with multiscale human ventricular models based on human electrophysiological and magnetic resonance imaging data (control and HF).RESULTS For patients with APV-ALT k-score >1.7, complex action potential duration (APD) oscillations (>= 2.3% of mean APD), rather than APD alternans, most accurately predicted VT/VF during long-term follow-up (+82%; -90% predictive values). In the failing human ventricular models, abnormal sarcoplasmic reticulum (SR) calcium handling caused APV-ALT (>1 mV) during pacing with a cycle length of 550 ms, which transitioned into large magnitude (>100 ms) discordant repolarization time alternans (RT-ALT) at faster rates. This initiated VT/VF (cycle length