Outcomes of Premature Ventricular Contraction-Cardiomyopathy in the Veteran Population: A Secondary Analysis of the CHF-STAT Study.
Outcomes of Premature Ventricular Contraction-Cardiomyopathy in the Veteran Population: A Secondary Analysis of the CHF-STAT Study.
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DOI：
10.1016/j.jacep.2020.08.028
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发表时间：
2021-03
影响因子：
7
通讯作者：
Singh, Steven N.
中科院分区：
文献类型：
--
作者：
Huizar, Jose F.;Fisher, Susan G.;Ramsey, Frederick, V;Kaszala, Karoly;Tan, Alex Y.;Moore, Hans;Koneru, Jayanthi N.;Kron, Jordana;Padala, Santosh K.;Ellenbogen, Kenneth A.;Singh, Steven N.
关键词：
室性早搏 (PVC) 与心力衰竭和 PVC 心肌病有关。 PVC 心肌病的患病率和抑制 PVC 的效果尚不清楚。我们试图从 CHF-STAT 试验中评估室性早搏心肌病的发生率和结果，该试验是针对患有心肌病（左心室射血分数 <40%）和频繁室性早搏（每小时 >10 次室性早搏）的人群。对 CHF-STAT 研究进行了二次分析，以比较 6 个月时胺碘酮组和安慰剂组之间的 PVC 抑制成功率（PVC 减少 ≥80%）、“LV 恢复”（定义为 LVEF 改善≥10% 点）和 PVC 心肌病。如果 6 个月时 PVC 减少 ≥80% 且 LVEF 改善 ≥10%，则定义为 PVC 心肌病。在 5 年随访期间比较 PVC 心肌病与非 PVC 心肌病的心脏事件（死亡或复苏性心脏骤停）。无论心肌病病因如何，胺碘酮组的 PVC 抑制成功率和 LV 恢复率（分别为 72% 和 39%）显着高于安慰剂组（分别为 12% 和 16%；P<0.001）。胺碘酮组和安慰剂组的 PVC 心肌病发病率分别为 29% 和 1.8%（P<0.001）。在缺血性人群（胺碘酮为 24%，安慰剂为 2%，P<0.001）和非缺血性人群（胺碘酮为 41%，安慰剂为 1.5%，P<0.001）中，PVC 心肌病发生率相似。 PVC 心肌病患者和接受胺碘酮治疗的患者的死亡和心脏骤停复苏率显着降低。在 CHF-STAT 研究中，无论缺血性基质如何，PVC 心肌病的总体患病率都很显着（总体人群为 29%；非缺血性心肌病为 41%）。用胺碘酮治疗 PVC 心肌病可能会提高这一高危人群的生存率。 CHF-STAT 研究是一项随机双盲对照研究，比较了 LVEF < 40% 和每小时 > 10 个 PVC 的患者的胺碘酮与安慰剂，进行了二次分析，以比较 PVC 心肌病的发生率和结果。在 CHF 研究中，无论心肌病病因如何，成功抑制 PVC 的胺碘酮治疗组中 PVC 心肌病的患病率显着较高。 PVC 心肌病患者的死亡和心脏骤停复苏率显着降低。这是第一个证明用胺碘酮抑制室性早搏对室性早搏心肌病患者的生存获益的临床试验。
Premature ventricular contractions (PVCs) are associated with heart failure and PVC-Cardiomyopathy. The prevalence of PVC-Cardiomyopathy and outcome benefits of PVC suppression are not clear. We sought to assess the rate and outcomes of PVC-Cardiomyopathy from the CHF-STAT trial, a population with cardiomyopathy (LV ejection fraction <40%) and frequent PVCs (>10 PVCs per hour). A secondary analysis of the CHF-STAT study was performed to compare the rate of successful PVC suppression (≥80% PVC reduction), “LV-recovery” (defined as improvement in LVEF ≥10% points) and PVC-Cardiomyopathy between amiodarone and placebo groups at 6 months. PVC-Cardiomyopathy was defined if both, ≥80% PVC reduction and LVEF improvement ≥10% were present at 6 months. Cardiac events (death or resuscitated cardiac arrest) were compared between PVC-Cardiomyopathy vs. non-PVC-Cardiomyopathy during a 5- year follow-up. The rate of successful PVC suppression and LV-recovery were significantly higher in the amiodarone (72 and 39%, respectively) when compared to the placebo group (12 and 16%, respectively; P<0.001), regardless of cardiomyopathy etiology. PVC-Cardiomyopathy was present in 29% and 1.8% of amiodarone and placebo groups, respectively (P<0.001). Similar PVC-Cardiomyopathy rates were found in ischemic (24% amiodarone vs. 2% placebo, P<0.001) and non-ischemic populations (41% amiodarone vs 1.5% placebo, P<0.001). Death and resuscitated cardiac arrest were significantly lower in patients with PVC-Cardiomyopathy and those treated with amiodarone. The overall prevalence of PVC-Cardiomyopathy in the CHF-STAT study was significant regardless of ischemic substrate (29% overall population; 41% non-ischemic cardiomyopathy). Treatment of PVC-Cardiomyopathy with amiodarone is likely to improve survival in this high-risk population. A secondary analysis of the CHF-STAT study, a randomized double-blind controlled study comparing amiodarone vs. placebo in patients with LVEF <40% and >10 PVCs per hr, was performed to compare the rate and outcomes of PVC-Cardiomyopathy. The prevalence of PVC-Cardiomyopathy in the CHF study was significantly higher in the amiodarone-treated group with successful PVC suppression regardless of cardiomyopathy etiology. Death and resuscitated cardiac arrest were significantly lower in patients with PVC-Cardiomyopathy. This is the first clinical trial to demonstrate survival benefits of PVC suppression with amiodarone in patients with PVC-Cardiomyopathy.
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影响因子：
2.8
作者：
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作者：
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DOI：
10.1161/circep.115.003047
发表时间：
2015-10
期刊：
Circulation. Arrhythmia and electrophysiology
影响因子：
--
作者：
Potfay J;Kaszala K;Tan AY;Sima AP;Gorcsan J 3rd;Ellenbogen KA;Huizar JF
通讯作者：
Huizar JF