Risk stratification using heart rate turbulence and ventricular arrhythmia in MADIT II: Usefulness and limitations of a 10-minute Holter recording
Risk stratification using heart rate turbulence and ventricular arrhythmia in MADIT II: Usefulness and limitations of a 10-minute Holter recording
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DOI：
10.1111/j.1542-474x.2004.93600.x
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发表时间：
2004-07-01
影响因子：
1.9
通讯作者：
Pitschner, HF
中科院分区：
文献类型：
--
作者：
Berkowitsch, A;Zareba, W;Pitschner, HF
背景资料：我们评估了心率震荡（HRT）参数和室性早搏（VPBs）频率对多中心自动除颤器试验II（MADIT II）中入选的左室功能低下的梗死后患者进行风险分层的有用性。方法：在884例MADIT II患者中，在入选时进行10分钟霍尔特监测，以评估HRT参数和室性早搏频率。主要终点定义为随机分配到常规治疗组的患者的全因死亡率和随机分配到植入式心律转复除颤器（ICD）治疗组的患者的室性心动过速或颤动的适当治疗。（2.3 vs 4.5 ms/RR; P < 0.05）;但在调整临床协变量（年龄、射血分数、β受体阻滞剂使用和BUN水平）后，它不是死亡率的显著预测因子。HRT参数与ICD患者的心血管事件之间无相关性。死亡的常规治疗患者和接受适当ICD治疗的ICD患者发生VPB的频率显著高于未发生此类不良事件的患者。在调整临床协变量后，常规组中>3/10 min的频繁室性早搏与死亡相关（HR = 1.63; P = 0.070），并预测ICD组的适当ICD治疗（HR = 1.75; P = 0.003）。在严重左心室功能不全的梗死后患者中，频繁的室性早搏与死亡风险增加和适当的ICID治疗相关。从10分钟霍尔特ECG获得的HRT在单变量分析中显示与死亡率相关的趋势，但在多变量分析中HRT参数不能预测结局。
Background: We evaluated the usefulness of heart rate turbulence (HRT) parameters and frequency of ventricular premature beats (VPBs) for risk-stratifying postinfarction patients with depressed left ventricular function enrolled in Multicenter Automatic Defibrillator Trial II (MADIT II).Methods: In 884 MADIT II patients, 10-minute Holter monitoring at enrollment was used to evaluate HRT parameters and frequency of VPBs. The primary endpoints were defined as all-cause mortality in patients randomized to conventional treatment and as appropriate therapy for ventricular tachycardia or fibrillation in patients randomized to implantable cardioverter defibrillator (ICD) therapy.Results: The median turbulence slope was lower in patients who died in comparison to survivors in the conventional arm (2.3 vs 4.5 ms/RR; P < 0.05); but it was not a significant predictor of mortality after adjustment for clinical covariates (age, ejection fraction, beta-blocker use, and BUN levels). There was no association between HRT parameters and arrhythmic events in ICD patients. Conventionally treated patients who died and ICD patients who had appropriate ICD therapy had significantly more frequent VPBs than those without such adverse events. After adjustment for clinical covariates, frequent VPBs>3/10 min were associated with death in the conventional arm (HR = 1.63; P = 0.070) and were predictive for appropriate ICD therapy in the ICD arm (HR = 1.75; P = 0.003).Conclusion: in postinfarction patients with severe left ventricular dysfunction, frequent VPBs are associated with increased risk of mortality and with appropriate ICID therapy. HRT obtained from 10-min Holter ECG showed a trend toward the association with mortality in univariate analysis but HRT parameters were not predictive of the outcome in multivariate analyses.