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在接受永久性心脏起器安置的患者中,节奏诱导的心肌病变
Jae Yeong Cho1, Sung Soo Kim2, Hyung Ki Jeong3
1Department of Cardiovascular Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, South Korea.
概括
右心室节拍可以导致节拍诱导心肌病变 (PICM) 在保存喷射分数 (EF) 的患者. 延长节奏QRS持续时间和减少全球纵向应变是PICM风险的关键预测因素.
科学领域:
- 心脏病学 心脏病学
- 电力生理学 电力生理学
- 心脏衰竭研究研究
背景情况:
- 已知慢性右心室 (RV) 节奏在患有低射出率 (EF) 的患者中会加剧心力衰竭.
- 在保存EF的患者中,节奏诱导心肌病 (PICM) 的影响和危险因素仍然不太清楚.
- 这项研究调查了PICM的发病率和预测因子,在一组接受永久心脏起器植入的保存EF患者中.
研究的目的:
- 为了确定患有保存喷射分数 (EF) 的患者节奏诱导心肌病 (PICM) 的危险因素.
- 评估RV节奏和PICM在这个特定患者群体中的发展之间的关联.
- 评估全球纵向应变 (GLS) 和节奏QRS持续时间 (pQRSd) 对PICM发展的预测值.
主要方法:
- 一项前性注册研究包括了de novo患者,EF ≥50%,接受了用于心房静脉阻塞的输血永久心脏起器 (PPM) 植入.
- 在2017年至2021年期间,预期心室节奏≥40%的患者被纳入.
- 综合结果包括心脏病死亡,心力衰竭住院,PICM和双心室节拍 (BVP) 升级. 考克斯回归分析用于识别独立预测因子.
主要成果:
- 在168名患者中,他们进行了3年的随访,其中16名患有PICM.
- PICM与减少的全球纵向应变 (GLS) 和延长的节奏QRS持续时间 (pQRSd) 相关.
- 确定pQRSd (HR 1.111) 和减少的GLS (HR 1.569) 是PICM的独立预测因素. GLS 显示出高预测准确度 (AUC 0.84).
结论:
- 右心室节奏带来了发展节奏诱导心肌病 (PICM) 的风险,即使是在保留喷射分数的患者中.
- 降低全球纵向应变 (GLS) 和延长节奏QRS持续时间 (pQRSd) 是识别高风险个体的有价值指标.
- 这些发现可以帮助风险分层,并可能指导节奏策略,以减轻保留EF患者的PICM.
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