心電學(xué)預(yù)警心衰猝死的風(fēng)險-資料下載頁
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【導(dǎo)讀】心電學(xué)預(yù)警心衰猝死的風(fēng)險。中國醫(yī)學(xué)科學(xué)院中國協(xié)和醫(yī)科大學(xué)。國家心血管病中心阜外心血管病醫(yī)院。在中國：180萬/每年！據(jù)估計,2020年美國有1300萬冠心病患者1. 猝死在50%男性和63%的女性是冠心病患者的首發(fā)表現(xiàn)1. 在西方國家,冠心病占心臟性猝死的至少80%3. 在心肌梗死的住院患者中，心臟性猝死的發(fā)生率約為%. *離子通道異常,瓣膜或先心病,其他原因。（三）心肺復(fù)蘇時間與成功率的關(guān)系。對猝死的征服中，ICD已邁出了第一步。2）壓力反射敏感性試驗。6）竇性心律震蕩。11）平板運(yùn)動試驗
【正文】 R 明顯異常 ? 意義 ：（ 1） TO與 TS均異常是總死亡率敏感的預(yù)測指標(biāo)，并有獨立的死亡預(yù)測的重要價值； （ 2） 現(xiàn)有資料顯示， HRT異常與死亡率增加相關(guān)。但尚需要進(jìn)一步的研究，以便明確 HRT在危險分層中是否具有臨床應(yīng)用價值 . Heart Rate Turbulence ? in an ATRAMI substudy,[1] there was a relative risk of 4 in multivariate analysis. A posite autonomic index, which included BRS and timedomain measures of HRV, increased the relative risk to 8. A smaller number of studies of patients with nonischemic dilated cardiomyopathy, chronic congestive heart failure, or hypertrophic cardiomyopathy (HCM) and patients undergoing revascularization have also suggested a predictive value of heart rate turbulence. ? In the Marburg Cardiomyopathy Study of 242 patients with nonischemic dilated cardiomyopathy, heart rate turbulence onset was a multivariate predictor of transplantfree survival (relative risk , 95% CI to ) but not of arrhythmic events. A, et al. Am J Cardiol. 2020。89:184–190. 2020年 AHA/ACC/HRS 無創(chuàng)技術(shù)對心臟性猝死危險分層專家共識 四、有關(guān)指南的評價 2020年 ACC/AHA 診斷和處理成年人心衰的指南 四、有關(guān)指南的評價 12導(dǎo)聯(lián) ECG和 Holter 在心衰評估中的作用 ? A 12lead electrocardiogram may demonstrate evidence of prior MI, LV hypertrophy, cardiac conduction abnormality (., left bundlebranch block), or a cardiac arrhythmia. ? Routine use of ambulatory electrocardiographic monitoring, Twave alternans analysis, heart rate variability measurement, and signal averaged electrocardiography have not been shown to provide incremental value in assessing overall prognosis, although ambulatory electrocardiographic monitoring can be useful in decision making regarding placement of ICDs. Circulation. 2020。119:e391e479 2020 ACC/AHA 心衰指南 ? Approximately 50% to 70% of patients with low EF and symptomatic HF have episodes of nonsustained VT on routine ambulatory electrocardiographic monitoring。 however, it is not clear whether the occurrence of plex ventricular arrhythmias in these patients with HF contributes to the high frequency of sudden death or, alternatively, simply re?ects the underlying disease process ? Approximately onethird of patients with low EF and class III to IV symptoms of HF manifest a QRS duration greater than electrocardiographic representation of abnormal cardiac conduction has been used to identify patients with dyssynchronous ventricular contraction. 2020 ACC/AHA 心衰指南 2020年 ACCF/AHA 處理心力衰竭的指南 四、有關(guān)指南的評價 2020 心衰指南 2020年 ESC 診斷和處理急性和慢性心衰的指南 四、有關(guān)指南的評價 2020 ESC 心衰指南 心電圖的作用 ? The ECG shows the heart rhythm and electrical conduction, . whether there is sinoatrial disease, atrioventricular (AV) block, or abnormal intraventricular conduction (see Table 5). These ?ndings are also important for decisions about treatment (. rate control and anticoagulation for AF, pacing for bradycardia, or CRT if the patient has LBBB) (see Section on treatment). ? The ECG may also show evidence of LV hypertrophy or Q waves (indicating loss of viable myocardium), giving a possible clue to the aetiology of HF. HF is very unlikely (likelihood,2%) in patients presenting acutely and with a pletely normal ECG. In patients with a nonacute presentation, a normal ECG has a somewhat lower negative predictive value (likelihood,10–14%). 心衰患者常見的心電圖異常 能行走的疑診為心衰的患者 行診斷性檢查的建議 可疑心衰的診斷流程 心衰患者行 CRT治療的心電圖標(biāo)準(zhǔn)建議 謝謝 ！
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