不同起源部位室性早搏对心力衰竭患者预后的影响

目的:探讨不同起源部位的室性早搏对心力衰竭(心衰)患者预后的影响。方法:回顾性分析2007-11到2010-12期间在我院住院患者中左心室射血分数≤40%的心衰患者206例,随访1年,8例失访。分析临床各项指标和不同起源部位室性心律失常与心血管死亡间的关系。根据患者是否死亡,将患者分为生存组(n=161)和心血管死亡组(n=37)。结果:与生存组比较,心血管死亡组房室传导阻滞(AVB),24小时平均心率,室性早搏(室早)LOWN分级4A、4B级,室早,非持续性室速发生率;非持续性室速阵数及最快频率,起源于左心室流入道的室早、起源于左心室流入道的非持续性室速均增加,无房室传导阻滞,室早LOWN分级0、1、2、3级发生率均减少,差异有统计学意义(P<0.05)。logistic回归分析表明:收缩压、糖尿病、Ca2+、左心室射血分数、24小时平均心率、室早次数、起源左心室流入道的室早、非持续性室速的阵数是心血管死亡的独立危险因素。结论:室早对判断患者预后有重要价值,起源于左心室流入道室早增加心衰患者心血管死亡率。

Effect of Premature Ventricular Contraction From Different Origins onPrognosis in Patients With Chronic Heart Failure

Objective:To explore the effect of premature ventricular contraction(PVC)from different origins on prognosis in patients with chronic heart failure(CHF). Methods:We retrospectively analyzed 206 CHF patients with left ventricular ejection fraction(LVEF)≤40% who were treated in our hospital from 2007 to 2010.The patients received 1 year followed-up study for their clinical characteristics,the relationship between cardiovascular mortality and the ventricular arrhythmia from different origins by ambulatory ECG(AECG)parameters.The patients were divided into two groups as Survival group,n=161 and Cardiac death group,n=37.There were 8 patients lost contact. Results:Compared with Survival group,Cardiac death group had increased A-V block,24h-average heart rate,number of PVC,presence of non-sustained ventricular tachycardia(NSVT),frequency of NSVT episode,fastest rate of NSVT,PVC originating from left ventricular inflow tract(LVIT)and NSVT originating from LVIT.They also showed less LOWN grade 0,1,2,3 of PVC.All P<0.05.Logistic analysis presented that systolic blood pressure,diabetes,Ca2+,LVEF,24h-average heart rate,number of PVC,PVC from LVIT,frequency of NSVT episode were the independent risk factors for cardiovascular death. Conclusion:PVC from different origin is important to evaluate the prognosis of CHF.PVC from LVIT could increase the cardiovascular mortality in CHF patients.