Left ventricular dysfunction is a risk factor for sudden cardiac death in adults late after repair of tetralogy of Fallot
Left ventricular dysfunction is a risk factor for sudden cardiac death in adults late after repair of tetralogy of Fallot
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DOI：
10.1016/s0735-1097(02)02344-6
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发表时间：
2002-11-06
影响因子：
24
通讯作者：
Therrien, J
中科院分区：
文献类型：
--
作者：
Ghai, A;Silversides, C;Therrien, J
目的：本研究的目的是确定左室（LV）收缩功能障碍是否是法洛四联症（TOF）修复后晚期成人心源性猝死（SCD）的预测因子。背景：先前关于TOF修复成人SCD危险因素的研究主要集中在右心室（RV）。方法对在多伦多成人先天性心脏中心评估的患者进行回顾性图表回顾。选择成年性TOF合并SCD患者12例（SCD组）。随机选取125例健在的成年TOF修复患者作为对照（对照组）。结果SCD患者更容易出现中度或重度肺反流（92%对51%，p = 0.02），有持续性室性心动过速史（42%对6%，p < 0.01）， QRS大于等于180 ms（56%对13%，p = 0.02）。中度或重度左室收缩功能障碍在SCD患者中也明显比对照组更常见（42%比9%，p < 0.01），阳性预测值为29%。中度或重度左室收缩功能障碍和QRS大于或等于180 ms的合并对SCD的阳性和阴性预测值分别为66%和93%。结论：中度或重度左室收缩功能障碍在成年TOF和SCD修复患者中更为常见。QRS 180 ms与明显左室收缩功能障碍的结合对SCD具有较高的阳性和阴性预测价值。预防性抗心律失常植入式心脏除颤器插入在这些患者中的作用需要进一步阐明。(C) 2002年由美国心脏病学会基金会发布。
OBJECTIVES The purpose of this study was to determine if left ventricular (LV) systolic dysfunction was also a predictor of sudden cardiac death (SCD) in adults late after repair of tetralogy of Fallot (TOF).BACKGROUND Previous studies looking at risk factors for SCD in adults with repair of TOF have focused on the right ventricle (RV).METHODS A retrospective chart review of patients assessed at the Toronto Congenital Cardiac Centre for Adults was performed. Twelve adult patients with repaired TOF and SCD were identified (SCD group). A total of 125 living adult patients with repaired TOF were randomly selected for comparison (control group).RESULTS Patients with SCD were more likely to exhibit moderate or severe pulmonary regurgitation (92% vs. 51%, p = 0.02), have a history of sustained ventricular tachycardia (42% vs. 6%, p < 0.01), and have a QRS greater than or equal to180 ms (56% vs. 13%, p = 0.02). Moderate or severe LV systolic dysfunction was also significantly more common in patients with SCD than in the control group (42% vs. 9%, p < 0.01) with a positive predictive value of 29%. The combination of moderate or severe LV systolic dysfunction and QRS greater than or equal to180 ms had a positive and negative predictive value for SCD of 66% and 93%, respectively.CONCLUSIONS Moderate or severe LV systolic dysfunction is significantly more common in adult patients with repaired TOF and SCD. The combination of QRS 180 ms and significant LV systolic dysfunction has high positive and negative predictive value for SCD. The implication of the role of prophylactic antiarrhythmic implantable cardiac defibrillator insertion in these patients needs further elucidating. (C) 2002 by the American College of Cardiology Foundation.