在心脏再同步治疗后,左心室射出小部分改善的患者中预测心室心律不整
Adam Visca1, Saadia Sherazi1, Ilan Goldenberg1
1Division of Cardiology, Clinical Cardiovascular Research Center, School of Medicine and Dentistry, University of Rochester, Rochester, New York, USA.
用除器 (CRT-D) 进行心脏再同步治疗后改善左心室喷射率 (LVEF) 的患者仍然可能面临心室动脉节律失常 (VTA) 风险. 对于那些具有特定风险因素的人来说,尽管LVEF收益,但密切监测至关重要.
科学领域:
- 心脏病学 心脏病学
- 电子生理学 电子生理学
- 医疗器械 医疗器械
背景情况:
- 在许多患者中,用除器 (CRT-D) 进行心脏再同步治疗可以改善左心室喷射率 (LVEF).
- 然而,一些患者仍然面临心室动脉节律失常 (VTA) 的风险,即使LVEF有显著的改善.
研究的目的:
- 在CRT-D患者中确定VTA的预测因子,这些患者的LVEF改善超过了指南建议.
- 定义一个需要更密切监督的高风险子组.
主要方法:
- 对多中心自动除器植入试验与心脏再同步治疗 (MADIT-CRT) 试验中的患者的分析.
- 纳入标准:CRT-D手臂,植入后12个月LVEF>35% (N=651).
- 考克斯比例危险回归用于评估适合植入式心脏转换器-除器 (ICD) 治疗VTA的预测因素.
主要成果:
- 确定了VTA的三个关键预测因素:LVEF改善在36%-40%的范围内 (HR 1.97),基线非左捆分支块 (LBBB) ECG形态 (HR 1.93) 和CRT-D后第一年内VTA发生 (HR 4.91).
- 患有这些因素的患者面临着明显更高的VTA风险,尽管LVEF有所改善.
结论:
- 尽管LVEF显著改善,但CRT-D治疗的部分患者仍然面临高风险的VTA.
- 这些患者需要谨慎监测,即使LVEF超过标准ICD指南值.
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