周期反极化动力学识别了非缺血性心肌病的ICD响应者:丹麦子研究
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
概括
定期复极化动态 (PRD) 可以识别受益于植入式心动除器 (ICD) 治疗的非动脉动脉病患者. 在ICD植入后,较高的PRD值与显著的死亡率降低有关.
科学领域:
- 心脏病学
- 电生理学
- 医疗器械
背景情况:
- 非缺血性心肌病可能导致心脏突然死亡.
- 预防性植入式心脏除器 (ICD) 植入是一种预防心脏突然死亡的策略.
- 确定哪些患者将从ICD中获益最大仍然是一个临床挑战.
研究的目的:
- 调查周期性复极化动态 (PRD) 是否可以识别患有非缺血性心肌病的患者,这些患者可以从预防性ICD植入中获益.
- 评估PRD与非缺血性心肌病患者全因死亡率之间的关联.
- 探讨PRD与ICD治疗对降低死亡率的相互作用.
主要方法:
- 后期分析丹麦试验数据.
- 包括非缺血性心肌病患者,LVEF≤35%,NT- proBNP升高.
- 使用波形分析对24小时的霍尔特记录进行PRD评估.
- 对多个临床变量进行了调整.
主要成果:
- PRD与死亡率独立相关 (HR为每次SD增加1. 28; P=0. 003).
- 在对照组中,PRD与死亡率有显著的关联,但在ICD组中没有.
- 一个显著的相互作用 (P=0. 008) 显示,PRD≥10度的患者在ICD植入后的绝对死亡率降低了17. 5% (NNT=6).
结论:
- 增加PRD是非缺血性心肌病死亡风险增加的标志物.
- PRD可以确定从预防性ICD植入中获得显著生存益处的患者.
- PRD可能有助于优化患者选择ICD治疗.
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