Left ventricular remodeling in premature ventricular contraction-induced cardiomyopathy: Effect of coupling intervals and atrioventricular dissociation.
Left ventricular remodeling in premature ventricular contraction-induced cardiomyopathy: Effect of coupling intervals and atrioventricular dissociation.
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DOI：
10.1016/j.hroo.2023.07.008
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发表时间：
2023-09
期刊：
影响因子：
--
通讯作者：
Huizar, Jose F.
中科院分区：
文献类型：
--
作者：
Shoureshi, Pouria;Kabadi, Rajiv;James, Nicholas;Torrado, Juan F.;Airapetov, Sergei;Hundley, William;Kaszala, Karoly;Ellenbogen, Kenneth A.;Tan, Alex Y.;Huizar, Jose F.
关键词：
左室不同步（LVD）和期外收缩后增强（PESP）与室性早搏（PVC）相关，可能在室性早搏诱导的心肌病（PVC-CM）的发生中起作用。长偶联（LC）PVC具有比短偶联（SC）PVC更大的LVD，而SC-PVC具有比LC-PVC更强的PESP。本研究的目的是比较SC-PVC和LC-PVC，以评估LVD，PESP和房室分离（AVD）在PVC-CM发展中的作用。36只犬接受起搏器植入术，诱导二联右心室心尖部心外膜PVC（50%负荷），持续12周。遥测评估PVC负荷和AVD。将动物分组为SC-PVC（偶联间期[CI] 200- 220 ms）、LC-PVC（CI 330 ms）或假手术（对照）。超声心动图的变化，AVD和血流动力学监测12周。SC-PVC和LC-PVC组的PVC负荷相似，但SC-PVC组的PVC负荷在统计学上更高（50% vs 47.5%; P = 0.028）。12周后，与假手术组（61% ± 1.6%; P <0.001）相比，SC-PVC和LC-PVC组的左心室射血分数（LVEF）均显著降低（分别为47.1% ± 1.4%和45.5% ± 2%）。SC-PVC和LC-PVC组的总体AVD相似，12周时AVD与LVEF降低之间无显著相关性（分别为r = 0.09，P = 0.5; r = 0.06，P = 0.8）。此外，与基线相比，12周后SC-PVC和LC-PVC组的最大和最小dP/dt均大幅下降。PVC CI和AVD均未在PVC-CM的发生或严重程度中发挥独立作用。LVD和PESP对PVC-CM的发展贡献相当。
Left ventricular dyssynchrony (LVD) and postextrasystolic potentiation (PESP) associated with premature ventricular contractions (PVCs) may play a role in the development of premature ventricular contraction–induced cardiomyopathy (PVC-CM). Long-coupled (LC) PVCs have a greater LVD than short-coupled (SC) PVCs, whereas SC-PVCs have a stronger PESP than LC-PVCs. The purpose of this study was to compare SC-PVCs and LC-PVCs to evaluate the roles of LVD, PESP, and atrioventricular dissociation (AVD) in the development of PVC-CM. Thirty-six canines underwent pacemaker implantation to induce bigeminal right ventricular apical epicardial PVCs (50% burden) for 12 weeks. Telemetry assessed PVC burden and AVD. Animals were grouped as SC-PVC (coupling interval [CI] 200–220ms), LC-PVC (CI 330 ms), or sham (control). Echocardiographic changes, AVD, and hemodynamics were monitored for 12 weeks. PVC burden was similar between SC-PVC and LC-PVC groups but was statistically higher in the SC-PVC group (50% vs 47.5%; P = .028). After 12 weeks, left ventricular ejection fraction (LVEF) significantly decreased in both SC-PVC and LC-PVC groups (47.1% ± 1.4% and 45.5% ± 2%, respectively) compared to sham group (61% ± 1.6%; P <.001). Overall AVD was similar between SC-PVC and LC-PVC groups, and there was no significant correlation between AVD and reduction in LVEF at 12 weeks (r = 0.09, P = .5; and r = 0.06, P = .8, respectively). Additionally, both SC-PVC and LC-PVC groups experienced substantial declines in max and min dP/dt after 12 weeks compared to baseline. Neither PVC CI nor AVD played an independent role in the development or severity of PVC-CM. LVD and PESP make equal relative contributions to the development of PVC-CM.
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