在射频消融患者中室性期前收缩诱发性心肌病的发生及影响因素分析

Influencing factors of premature ventricular contraction-induced cardiomyopathy

目的:观察射频消融患者中的室性期前收缩诱发性心肌病(PVC-ICM)发生情况和影响因素,以及患者术后心脏结构和功能的变化。方法:连续选取2011年1月至2014年2月于北京安贞医院住院,并拟行射频消融术治疗的频发室性期前收缩患者322例。登记患者的年龄、性别、室性期前收缩病程、有无室性期前收缩相关症状,登记术前心电图(ECG)、24小时动态心电图(Holter)及超声心动图(UCG)的相关指标。心内电生理检查及射频消融术后,记录早搏起源部位。所有患者在术后6个月时行Holter及UCG检查。入选患者分为PVC-ICM组(n=54)及无心肌病组(n=233),比较两组患者的术后左心室舒张末径(LVEDD)及左心室射血分数(LVEF)的变化,并用多因素二元Logistic逐步回归分析PVC-ICM的影响因素。本研究PVC-ICM的诊断标准:射频消融术前LVEDD增大,消融成功后(室性期前收缩数目减少>80%)LVEDD恢复正常。结果:共287例患者符合入组标准并完成随访,PVC-ICM组54例(18.8%)。多因素分析显示,室性期前收缩负荷(%)(OR=1.040,P=0.007)、病程(年)(OR=1.057,P=0.015)、室性期前收缩QRS波时程(ms)(OR=1.021,P=0.034)及无症状室性期前收缩(OR=2.379,P=0.046)为PVC-ICM的独立危险因素。射频消融术前PVC-ICM组的LVEDD值明显大于无心肌病组[(55.8±3.7)vs.(47.7±3.5)mm,P<0.001],LVEF值明显低于无心肌病组[(58.6±8.0)vs.(63.1±5.1)%,P<0.001];术后PVC-ICM组患者的LVEDD[(47.1±2.8)vs.(46.9±3.1)mm,P=0.685]及LVEF[(62.0±3.9)vs.(63.2±5.0)%,P=0.086]均达到与无心肌病组一致的水平;两组间手术前后比较显示,PVC-ICM组患者的LVEDD(P<0.001)及LVEF(P<0.001)值均得到改善,而无心肌病组患者术后两项指标均无显著改变(LVEDD:P=0.053;LVEF:P=0.066)。结论:存在较大的室性期前收缩负荷、较长的病程、较长的室性期前收缩QRS波时程以及无症状的室性期前收缩患者更易发生PVC-ICM,射频消融术对PVC-ICM患者的心脏结构及心功能均有明显改善效果。

Objective： To investigate the occurrence and influencing factors of premature ventricular contraction-induced cardiomyopathy （ PVC-ICM ） in patients after radiofrequency ablation （RFCA） therapy, and determine the changes of cardiac structure and function in patients. Methods： From January 2011 to April 2014, a total of 322 patients with frequent premature ventricular contractions（PVCs） who were admitted to Bei- jing Anzhen Hospital for radiofrequency ablation therapy were consecutively selected. We recorded age, sex, course of PVCs, with or without PVCs-related symptoms of every patients. We recorded relevant indicators of ECG, 24-hour Holter monitoring （Hoher） and echocardiogram （UCG）. The original site of PVCs was recorded according to electrophysiologieal study （EPS） and RFCA. 6 months after RFCA, Hoher and UCG were per- formed again. Patients were divided into 2 groups ： PVC-ICM group （ n = 54 ） and non-cardiomyopathy group （ n= 233）. We compared the changes of left ventricular end-diastolic dimension （LVEDD） and left ventricular e- jection fraction（ LVEF） between the two groups, and got the influencing factors of PVC-ICM using multi-factor binary logistic regression analysis. The diagnostic standard of PVC-ICM in this subject： LVEDD was higher than normal before RFCA and got normal after successful RFCA（ decrease of the amount of PVCs was 〉 80% ）. Results： 287 patients were admitted and completed the subject. 54 （ 18.8% ） patients were included in PVC- ICM group. Multi-factor binary logistic regression analysis showed that PVC burden （ % ） （ OR = 1. 040, P = 0. 005 ） , course of PVCs （year） （ OR = 1. 057, P = O. 015 ） , QRS complex duration of PVCs （ms） （ OR = 1. 021, P =0. 034）and being asymptomatic were independently associated with PVC-ICM. Before RFCA, LVEDD of PVC-ICM group was significantly greater than non-cardiomyopathy group [ （ 55.8 ± 3.7 ） vs. （47.7 ± 3.5 ） mm, P 〈0. 001 ] , and LVEF were significantly lower than non-cardiomyopathy group[ （58.6 ± 8.0） vs. （63.1 ± 5.1 ） % ,P 〈 O. 001 ]. After RFCA, both LVEDD [ （47.1± 2.8） vs. （46.91±3.1 ） mm,P =0. 685 ] and LVEF [ （ 62. 085 ] ） vs. （63.2 ± 5.0） %, P = 0.086 ] of PVC-ICM group achieved the similar level of non-eardiomyopa- thy group. Compared with themselves before surgery, both LVEDD （ P 〈 0. 001 ） and LVEF （ P 〈 0. 001 ） of PVC-ICM group got significant improvements, but neither of the two indexs of non-cardiomyopathy group had significantly changed （ LVEDD ： P = 0.053 ; LVEF ： P =0. 066 ）. Conclusion： A considerable part to the frequent PVCs patients would develop into PVC-ICM. There would be a bigger risk of the occurrence of PVC-ICM in patients with larger PVC burden, longer course of the disease, longer QRS complex duration of PVCs and being asymptomatic. RFCA can obviously improve the cardiac structure and function in PVC-ICM patients.