周期的再極化ダイナミクスは,非発血性心筋病におけるICD応答者を特定する:デンマークのサブ研究
Rune Boas1,2,3, Nikolay Sappler4, Lukas von Stülpnagel4,5
1Department of Cardiology, Amager Hvidovre University Hospital, University of Copenhagen, Denmark (R.B., U.D.).
Circulation
|December 10, 2021
まとめ
周期的な再偏振動 (PRD) は,インプラント可能な心筋動器 (ICD) 治療から恩恵を受ける非血動性心筋病の患者を特定することができます. PRD値の上昇は,ICDの導入後の死亡率の有意な低下と関連していた.
科学分野:
- 心臓病科
- 電気生理学
- 医療機器
背景:
- 非発血性心筋病は 心臓発作による突然死のリスクがあります.
- 予防的なインプラント可能な心動除細動器 (ICD) のインプラントは,突然の心臓死を予防する戦略です.
- ICDから最も恩恵を受ける患者を特定することは,臨床的な課題です.
研究 の 目的:
- 周期的な再偏極化ダイナミクス (PRD) によって,予防的なICD移植の恩恵を受ける非乳房性心筋病の患者を特定できるかどうかを調査する.
- 非発血性心筋病患者の全因死亡率との関連性を評価する.
- PRDとICD治療による死亡率低下の相互作用を調査する.
主な方法:
- DANISH試験のデータに関するポストホック分析
- 非乳房性心筋病患者,LVEF ≤35%,およびNT-proBNP値上昇を含む.
- 24時間ホルター記録のウェーブレット分析を用いてPRDの評価
- コックス回帰分析は複数の臨床変数で調整された.
主要な成果:
- PRDは独立して死亡率と関連していた (HR 1. 28/ SD増加,P=0. 003).
- PRDは対照群では死亡率と有意に関連していたが,ICD群ではそうではなかった.
- 有意な相互作用 (P=0. 008) により,PRD ≥10°2の患者は,ICD移植で絶対的な死亡率を17. 5%減少させた (NNT=6).
結論:
- 増加したPRDは非発血性心筋病の死亡リスクのマーカーです.
- PRDは,予防的なICDインプラントから生存に重大な利益をもたらす患者を特定することができます.
- PRDは,ICD治療のための患者の選択を最適化するのに役立ちます.
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