Adil Salihu, Panagiotis Antiochos, Henri Lu, Niccolò Maurizi, Pierre Monney, Patrizio Pascale
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引用次数: 0
摘要
背景：肥厚性心肌病（HCM）的心源性猝死（SCD）风险分层仍然具有挑战性。程序性电刺激（PES）尚未得到现行指南的认可，其在风险分层中的作用也存在争议。我们进行了一项系统回顾和荟萃分析，以评估HCM患者PES诱导性与主要心律失常事件（MAE）之间的关系，并评估其预测价值。方法：我们检索PubMed/MEDLINE， Embase和Cochrane图书馆，截至2024年2月1日，根据PES诱导性评估MAE （SCD，复苏心脏骤停或适当的植入式心脏转复除颤器干预）的研究。随机效应荟萃分析计算合并or和ci。敏感性、特异性和预测值也根据已发表的信息进行计算。结果：纳入5项研究（587例，男性66%，平均年龄38±14岁）。188例（32%）患者观察到PES诱导。在可诱导的患者中，MAE发生率为18%（34个事件），在不可诱导的患者中，MAE发生率为2%（8个事件）（OR 10.83, 95% CI 3.52 ~ 33.34）。结论：HCM患者可诱导PES发生MAE的风险增加10倍。需要进一步的前瞻性研究来验证其在当代风险分层工具背景下的独立预测价值。普洛斯彼罗注册号：CRD42024497521。
Association between programmed electrical stimulation inducibility and arrhythmic risk in hypertrophic cardiomyopathy: a systematic review and meta-analysis.
Background: Risk stratification for sudden cardiac death (SCD) in hypertrophic cardiomyopathy (HCM) remains challenging. Programmed electrical stimulation (PES) is not endorsed by current guidelines, and its role in risk stratification is debated. We conducted a systematic review and meta-analysis to assess the association between PES inducibility and major arrhythmic events (MAE) in patients with HCM and evaluate its predictive value.
Methods: We searched PubMed/MEDLINE, Embase and the Cochrane Library up to 1 February 2024, for studies assessing MAE (SCD, resuscitated cardiac arrest or appropriate implantable cardioverter-defibrillator interventions) according to PES inducibility. A random-effects meta-analysis was performed to calculate pooled ORs and CIs. Sensitivity, specificity and predictive values were also calculated from the published information.
Results: Five studies (587 patients, 66% male, mean age 38±14 years) were included. PES inducibility was observed in 188 (32%) patients. MAE occurred in 18% of inducible patients (34 events) and 2% of non-inducible patients (8 events) (OR 10.83, 95% CI 3.52 to 33.34, p<0.001, I²=27%). The sensitivity of PES for MAE was 81%, specificity was 72%, positive predictive value was 18%, and negative predictive value was 98%.
Conclusion: PES inducibility is associated with a 10 times higher risk of MAE in patients with HCM. Further prospective studies are needed to validate its independent predictive value in the context of contemporary risk stratification tools.
期刊介绍：
Heart is an international peer reviewed journal that keeps cardiologists up to date with important research advances in cardiovascular disease. New scientific developments are highlighted in editorials and put in context with concise review articles. There is one free Editor’s Choice article in each issue, with open access options available to authors for all articles. Education in Heart articles provide a comprehensive, continuously updated, cardiology curriculum.
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