心拍数は,インプラント可能なカーディオバーター-デフィブリレーター集団における結果を予測します
Mastaneh Ahmadi-Kashani1, David J Kessler, John Day
1Department of Medicine, University of Iowa Hospitals, 4426a JCP, 200 Hawkins Dr, Iowa City, IA 52242, USA.
Circulation
|November 11, 2009
まとめ
心拍数上昇 (HR) は,インプラント可能な心変容器-除細動器 (ICD) を使用している患者で,より悪い結果と関連しています. 高い平均HRは,死亡または心不全の入院のリスクの増加を独立して予測し,HRを重要な予後要因として強調します.
科学分野:
- 心臓病学 心臓病学
- 電気生理学 電気生理学
- クリニック・トライアル 臨床試験
背景:
- 心拍数上昇 (HR) は,一般人および心疾患の患者における心血管不良および死亡率の既知の危険因子です.
- 埋め込み式心動除細動器 (ICD) を投与している患者における結果の予測者としての平均HRの役割は,さらなる調査を必要としています.
研究 の 目的:
- 平均HRがICDインプラントを施した患者の全死亡率と心不全の入院を予測するという仮説を検証する.
- ICDを患っている患者の内在心拍数の予後的意義を決定する.
主な方法:
- ICDにおけるAV検索ヒステレスによる不必要なRVペースの抑制 (INTRINSIC RV) 試験のデータを分析し,1530人の患者で二重室型ICDを移植した.
- 平均HRは,1436人の患者の平均フォローアップ10.4ヶ月のデバイスヒストグラムから決定されました.
- Mantel-Haenszel ordinal chi (((2) テストとコックス回帰を用いた統計分析により,平均HRとプライマリエンドポイント (死亡または心不全の入院) の関係を評価した.
主要な成果:
- 高い内在性HRは,死亡または心不全の入院のリスクの増加と有意に関連していました (P<0.001).
- 平均HR >90bpmの患者は,平均HR <75bpmの患者と比較して,プライマリエンドポイントの3.6倍以上のリスクがありました.
- 多変量分析では,HRは,年齢,NYHAクラス,RVペースとともに,独立した有意な予測因子 (ハザード比1.34,P=0.0001) でした.
結論:
- 平均内在的なHRは,ICD患者の有害な結果の強力で独立した予測指標です.
- 平均HRは,ICD患者の管理において重要な予後マーカーと見なされるべきである.
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