左心室环状瘢痕患者的心律失常风险分层。

IF 8.4 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS
Vanda Parisi, Maddalena Graziosi, Luis R Lopes, Antonio De Luca, Ferdinando Pasquale, Giacomo Tini, Mattia Targetti, Maria R Cueto, Ana R Moura, Raffaello Ditaranto, Camilla Torlasco, Nevio Taglieri, Elena Nardi, Luigi Lovato, João B Augusto, Nazzareno Galiè, Lia Crotti, Alessio Gasperetti, Mauro Biffi, Camillo Autore, Marco Merlo, Iacopo Olivotto, Gianfranco Sinagra, Perry M Elliott, Elena Biagini
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引用次数: 0

摘要

目的:心脏磁共振(CMR)显示的左心室环状瘢痕与非缺血性心肌病患者的恶性心律失常有关。本研究旨在对这一表型进行全面评估,并确定危及生命的心律失常事件(LAEs)的风险因素,即心脏性猝死(SCD)、SCD流产和持续性室性心动过速的综合因素:在 6 个转诊中心确定了 115 名患者(中位年龄 39 [IQR:28-52],42% 为女性)。纳入标准为环状左心室瘢痕(同一切片中心外膜下/中壁晚期钆增强(LGE)的连续节段≥3个)以及致病/可能致病基因变异、心肌病家族史或心律失常性心肌病诊断中的一项。研究随访期间,LAEs的无存活率为60%(3.8例/100名患者/年);中位随访4.6年(IQR 1.7-8.4),无存活率为84%。在多变量分析中,前方 Q 波(HR:1.030,95% CI:1.014-1.046,p <0.001)、QRS 宽度(HR:4.642,95% CI:1.296-16.628,p=0.018)和 LV 舒张末期容积指数(LVEDVi)(HR:1.011,95% CI:1.001-1.021,每 mL/m2 增加,p=0.040)与 LAEs 独立相关;具有良好的鉴别力(Harrell's C-index=0.796)。确定了三个风险类别:正常心电图、异常心电图和无LAEs预测变量、异常心电图和≥1个LAEs预测变量,存活率分别从100%降至65%和49%(Log-rank检验=0.015):在这项研究中,左心室环状瘢痕表型与前Q波、QRS延长和LVEDVi增高相关的恶性心律失常发生率较高。心电图正常的亚组风险较低。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Arrhythmic risk stratification in patients with left ventricular ring-like scar.

Aims: Left ventricular (LV) ring-like scar on cardiac magnetic resonance (CMR) has been linked to malignant arrhythmias in patients with non-ischemic cardiomyopathy. This study aimed to perform a comprehensive evaluation of this phenotype and to identify risk factors for life-threatening arrhythmic events (LAEs), a composite of sudden cardiac death (SCD), aborted SCD, and sustained ventricular tachycardia.

Methods and results: One-hundred-fifteen patients (median age 39 [IQR 28-52], 42% females) were identified at 6 referral centres. Inclusion criteria were ring-like LV scar (≥ 3 contiguous segments with subepicardial/midwall late gadolinium enhancement (LGE) in the same slice) and one among: pathogenic/likely pathogenic genetic variant, family history for cardiomyopathy, or arrhythmogenic cardiomyopathy diagnosis. During the study follow-up, survival-free from LAEs was 60% (3.8 events/100 patients/year); at a median follow-up of 4.6 years (IQR 1.7-8.4) it was 84%. On multivariable analysis, anterior Q waves (HR:1.030, 95% CI:1.014-1.046, p < 0.001), QRS width (HR:4.642, 95% CI:1.296-16.628, p=0.018), and LV end-diastolic volume index (LVEDVi) (HR:1.011, 95% CI:1.001-1.021, per mL/m2 increase, p=0.040) were independently associated with LAEs; with good discrimination power (Harrell's C-index=0.796). Three risk categories were identified: normal ECG, abnormal ECG and no LAEs predictive variables, abnormal ECG and ≥ 1 LAEs predictive variables, with a decreasing survival from 100% to 65% and 49%, respectively (Log-rank test = 0.015).

Conclusions: In this study, the LV ring-like scar phenotype was associated with a high rate of malignant arrhythmias in presence of anterior Q waves, QRS prolongation, and increased LVEDVi. A normal ECG identified a lower risk subgroup.

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来源期刊
European journal of preventive cardiology
European journal of preventive cardiology CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
12.50
自引率
12.00%
发文量
601
审稿时长
3-8 weeks
期刊介绍: European Journal of Preventive Cardiology (EJPC) is an official journal of the European Society of Cardiology (ESC) and the European Association of Preventive Cardiology (EAPC). The journal covers a wide range of scientific, clinical, and public health disciplines related to cardiovascular disease prevention, risk factor management, cardiovascular rehabilitation, population science and public health, and exercise physiology. The categories covered by the journal include classical risk factors and treatment, lifestyle risk factors, non-modifiable cardiovascular risk factors, cardiovascular conditions, concomitant pathological conditions, sport cardiology, diagnostic tests, care settings, epidemiology, pharmacology and pharmacotherapy, machine learning, and artificial intelligence.
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