心電學(xué)預(yù)警心衰猝死的風(fēng)險(xiǎn)-文庫(kù)吧
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【正文】 stry found that pts with BBB had more extensive CAD, a lower mean LVEF, and higher 2year mortality than those with normal QRS duration. ? the presence of left bundlebranch block was an independent predictor of cardiovascular mortality due to SCD[3], a retrospective analysis of 669 pts with CHF of varying causes found that QRS duration ≥120 ms was independently associated with an increase in allcause mortality and SCD, especially in pts with LVEF ≤30%[4] [1]Park RC, et al. Circ Res. 1985。57:706 –717. [2]Akar FG, et al. Circ Res. 2020。95:717–725. [3] Freedman RA, et Am Coll Cardiol. 1987。10:73– 80. [4] Iuliano S, et al. Am Heart J. 2020。143:1085–1091. （二）室性早搏和非持續(xù)性室速 ? Patients with nonischemic cardiomyopathy are at increased risk of SCD and frequently have highgrade ventricular ectopy and NSVT [] ? In GESICA trial, which included a majority of pts with nonischemic cardiomyopathy, confirmed the prevalence of ventricular arrhythmias on AECG in pts with heart failure and LVEF 35%. NSVT was an independent predictor of mortality, but ventricular couplets appeared to be equally predictive.[3] Couplets and/or NSVT were detected in % of the study population, with a % mortality rate. The remaining %, without couplets or NSVT, had a lower mortality rate of %. J,et al. Chest. 1988。93:85–90 SK, et al. Am J Cardiol. 1983。51:507–512. HC, et al. Circulation. 1996。94: 3198–3203. ? In pts with nonischemic cardiomyopathy and congestive heart failure, LVEF 35%, and ventricular arrhythmias (NSVT or an average of 10 or more VPBs per hour), DEFINITE demonstrated a trend toward improvement in overall survival (hazard ratio , 95% CI to , P ) and a reduction in arrhythmic events (hazard ratio , 95% CI to ,P ) with ICD therapy. The mortality rate of the nonICD group was 7% per year, but no parison group of pts without ventricular arrhythmias was reported. （三）心率恢復(fù)和恢復(fù)性室性異位搏動(dòng) ? Immediately after graded exercise,heart rate normally falls in a biphasic manner, with an initial rapid decline occurring during the first 30 seconds to 1 minute of recovery. ? Imai K,et al. demonstrated that this initial steep descent is marked in athletes and attenuated in pts with heart failure and that it can be eliminated by administration of atropine. [1] ? The ideal recovery protocol and abnormal cutoff value are unclear。 some advocate an upright cooldown period with a cutoff value of 12 beats per minute into recovery, whereas others support a sitdown recovery with a cutoff value of 22 beats per minute at 2 minutes into recovery.[2]When a supine recovery is mandated, as in stress echocardiography, a cutoff value of 18 beats per minute has been described.[3] K, et al. J Am Coll Cardiol. 1994。24:1529–1535. 2. Shetler K, et al. J Am Coll Cardiol. 2020。38:1980–1987. J,et al. Circulation. 2020。104:1911–1916. ? A phenomenon related to heart rate recovery is ventricular ectopy during recovery, which has also been hypothesized to reflect parasympathetic activity. Occurrence of frequent or severe ventricular ectopy during the first 5 minutes of recovery after exercise has been linked to risk of death in pts without and with heart failure and/or coronary artery disease.[1,2] JP, et al. N Engl J Med. 2020。348: 781–790. ’Neill JO,et
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