在患有症状和无症状预兴奋症患者的风险评估
Anette Jemtrén1, Serkan Saygi2, Finn Åkerström2
1Heart and Lung Disease Unit, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden.
运动压力测试 (EST) 在预激发患者中排除高风险辅助途径时具有较低的负预测值. 建议进行电生理学研究 (EPS) 进行准确的风险评估,无论症状如何.
科学领域:
- 心脏病学 心脏病学
- 电子生理学 电子生理学
- 临床风险分层的临床风险分层
背景情况:
- 预兴奋综合征需要准确的风险分层来预防不良事件.
- 运动压力测试 (EST) 单独用于预激发风险评估的有效性仍在争论中.
- 区分高风险和低风险的辅助途径对于患者管理至关重要.
研究的目的:
- 评估EST在患有预兴奋症的患者中分层风险的诊断效用.
- 为了比较EST与电生理学研究 (EPS) 在识别高风险辅助路径方面的有效性.
- 确定症状状态是否会影响EST在风险评估中的可靠性.
主要方法:
- 在164名连续患者 (59名无症状,105名有症状) 的前兴奋前期前期研究中,他们接受了增量自行车EST和EPS.
- EST评估了运动期间预兴奋的损失.
- EPS测量了辅助通路有效耐火期 (APERP) 和最短的预激发RR间隔 (SPERRI),必要时使用异二醇.
主要成果:
- 四十五名患者 (27%) 显示低风险的 EST 发现;6人显示高风险的 EPS 发现 (SPERRI/APERP ≤ 250 ms).
- 低风险的EST对于排除高风险的AP的负预测值为51%.
- 在EPS期间,在69%的无症状患者和61%的有症状患者中发现了诱导性心律失常.
结论:
- 在EST期间突然失去预兴奋不足以排除高风险的辅助途径.
- 电生理学研究 (EPS),可能使用异二醇,对于所有预兴奋患者的准确风险评估至关重要.
- 症状并不能否定在综合性风险评估中对EPS的需要.
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