{"title":"左心室质量是非缺血性心肌病和 LBBB CRT 治疗后室性心律失常风险和性别差异的调节器。","authors":"Koji Higuchi MD, PhD, FHRS , Mahesh Manne MD, MPH , Patrick Tchou MD , Bryan Baranowski MD , Mandeep Bhargava MD , Thomas Callahan MD , Mina Chung MD, FHRS , Thomas Dresing MD , Ayman Hussein MD, FHRS , Mohamed Kanj MD , Kenneth Mayuga MD, FHRS , Shady Nakhla MD , Walid Saliba MD, FHRS , John Rickard MD , Oussama Wazni MD, FHRS , Pasquale Santangeli MD , Jakub Sroubek MD, PhD , Niraj Varma MA, MD, PhD","doi":"10.1016/j.hrthm.2024.07.106","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>The risk of ventricular arrhythmias (VAs) after cardiac resynchronization therapy (CRT) has been associated with ischemic disease/scar, sex, and possibly left ventricular mass (LVM).</div></div><div><h3>Objective</h3><div>The purpose of this study was to evaluate sex differences and baseline/postimplant change in LVM on VA risk after CRT implantation in patients with nonischemic cardiomyopathy and left bundle branch block.</div></div><div><h3>Methods</h3><div>In patients meeting the criteria, baseline and follow-up echocardiographic images were obtained for LVM assessment. VA events were reported from device diagnostics and therapies. VA risk was stratified by receiver operating characteristic (Youden index cutoff point) for baseline LVM and baseline/postimplant change in LVM. Multivariate Cox regression model was also used for VA risk stratification.</div></div><div><h3>Results</h3><div>One hundred eighteen patients (71 female patients [60.2%]; mean age 60.5 ± 11.3 years; left ventricular ejection fraction 19.2% ± 7.0%; QRS duration 165.6 ± 20 ms; LVM 313.9 ± 108.8 g) were enrolled and followed up for a median of 90 months (interquartile range 44–158 months). Thirty-five patients (29.6%) received appropriate shocks or antitachycardia pacing at a median of 73.5 months (interquartile range 25–130 months) postimplantation. Males had a higher VA incidence (male patients 18 of 47 [38.3%] vs female patients 17 of 71 [23.9%]; <em>P</em> = .02). Baseline LVM > 308.9 g separated patients with higher VA risk (<em>P</em> = .001). Less than a 20% decrease in LVM increased VA risk (<em>P</em> < .001). Baseline LVM was the only baseline characteristic predicting VA events in the Cox regression model (hazard ratio 1.01; 95% confidence interval 1.001–1.009; log-rank, <em>P</em> = .003). Sex differences in VA risk were eliminated by the baseline LVM parameters.</div></div><div><h3>Conclusion</h3><div>VA risk after CRT implantation in nonischemic cardiomyopathy was associated with baseline LV > 308.9 g and a decrease in LVM ≤ 20%, without sex differences.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 2","pages":"Pages 339-348"},"PeriodicalIF":5.6000,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Left ventricular mass as a modulator of ventricular arrhythmia risk and sex differences after CRT for nonischemic cardiomyopathy and LBBB\",\"authors\":\"Koji Higuchi MD, PhD, FHRS , Mahesh Manne MD, MPH , Patrick Tchou MD , Bryan Baranowski MD , Mandeep Bhargava MD , Thomas Callahan MD , Mina Chung MD, FHRS , Thomas Dresing MD , Ayman Hussein MD, FHRS , Mohamed Kanj MD , Kenneth Mayuga MD, FHRS , Shady Nakhla MD , Walid Saliba MD, FHRS , John Rickard MD , Oussama Wazni MD, FHRS , Pasquale Santangeli MD , Jakub Sroubek MD, PhD , Niraj Varma MA, MD, PhD\",\"doi\":\"10.1016/j.hrthm.2024.07.106\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>The risk of ventricular arrhythmias (VAs) after cardiac resynchronization therapy (CRT) has been associated with ischemic disease/scar, sex, and possibly left ventricular mass (LVM).</div></div><div><h3>Objective</h3><div>The purpose of this study was to evaluate sex differences and baseline/postimplant change in LVM on VA risk after CRT implantation in patients with nonischemic cardiomyopathy and left bundle branch block.</div></div><div><h3>Methods</h3><div>In patients meeting the criteria, baseline and follow-up echocardiographic images were obtained for LVM assessment. VA events were reported from device diagnostics and therapies. VA risk was stratified by receiver operating characteristic (Youden index cutoff point) for baseline LVM and baseline/postimplant change in LVM. Multivariate Cox regression model was also used for VA risk stratification.</div></div><div><h3>Results</h3><div>One hundred eighteen patients (71 female patients [60.2%]; mean age 60.5 ± 11.3 years; left ventricular ejection fraction 19.2% ± 7.0%; QRS duration 165.6 ± 20 ms; LVM 313.9 ± 108.8 g) were enrolled and followed up for a median of 90 months (interquartile range 44–158 months). Thirty-five patients (29.6%) received appropriate shocks or antitachycardia pacing at a median of 73.5 months (interquartile range 25–130 months) postimplantation. Males had a higher VA incidence (male patients 18 of 47 [38.3%] vs female patients 17 of 71 [23.9%]; <em>P</em> = .02). Baseline LVM > 308.9 g separated patients with higher VA risk (<em>P</em> = .001). Less than a 20% decrease in LVM increased VA risk (<em>P</em> < .001). Baseline LVM was the only baseline characteristic predicting VA events in the Cox regression model (hazard ratio 1.01; 95% confidence interval 1.001–1.009; log-rank, <em>P</em> = .003). Sex differences in VA risk were eliminated by the baseline LVM parameters.</div></div><div><h3>Conclusion</h3><div>VA risk after CRT implantation in nonischemic cardiomyopathy was associated with baseline LV > 308.9 g and a decrease in LVM ≤ 20%, without sex differences.</div></div>\",\"PeriodicalId\":12886,\"journal\":{\"name\":\"Heart rhythm\",\"volume\":\"22 2\",\"pages\":\"Pages 339-348\"},\"PeriodicalIF\":5.6000,\"publicationDate\":\"2025-02-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Heart rhythm\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1547527124030844\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Heart rhythm","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1547527124030844","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
摘要
背景：心脏再同步化治疗（CRT）后室性心律失常（VA）的风险与缺血性疾病/瘢痕、性别以及可能的左心室质量（LVM）有关：目的：评估非缺血性心肌病（NICM）和左束支传导阻滞患者植入 CRT 后的性别差异和 LVM 基线/植入后变化 [Δ]对 VA 风险的影响：在符合标准的患者中，获取基线和随访超声心动图图像以评估左心室容积。通过设备诊断和治疗报告VA事件。根据基线 LVM 和 ΔLVM 的 ROC（Youden 指数切点）以及使用多变量 Cox 回归模型的基线患者特征对 VA 风险进行分层：118 名患者（71[60.2%] 名女性，年龄 60.5 ±11.3 岁，LVEF 19.2 ±7.0%, QRS 165.6 ±20 ms, LVM 313.9 ±108.8 g）入组并接受了中位 90 (IQR 44-158) 个月的随访。35名患者（29.6%）在植入后中位数73.5个月（IQR 25-130）时接受了适当的电击或抗心动过速起搏。男性的 VA 发生率更高（男性 18/47 [38.3%] 对女性 17/71 [23.9%]，P=0.02）。基线 LVM >308.9g 的患者有较高的 VA 风险（P=0.001）。LVM 下降少于 20% 会增加 VA 风险（结论：CRT 后，NCD 患者的 VA 风险会增加：NICM患者CRT后的VA风险与基线LV>308.9g和LVM下降≤20%有关，无性别差异。
Left ventricular mass as a modulator of ventricular arrhythmia risk and sex differences after CRT for nonischemic cardiomyopathy and LBBB
Background
The risk of ventricular arrhythmias (VAs) after cardiac resynchronization therapy (CRT) has been associated with ischemic disease/scar, sex, and possibly left ventricular mass (LVM).
Objective
The purpose of this study was to evaluate sex differences and baseline/postimplant change in LVM on VA risk after CRT implantation in patients with nonischemic cardiomyopathy and left bundle branch block.
Methods
In patients meeting the criteria, baseline and follow-up echocardiographic images were obtained for LVM assessment. VA events were reported from device diagnostics and therapies. VA risk was stratified by receiver operating characteristic (Youden index cutoff point) for baseline LVM and baseline/postimplant change in LVM. Multivariate Cox regression model was also used for VA risk stratification.
Results
One hundred eighteen patients (71 female patients [60.2%]; mean age 60.5 ± 11.3 years; left ventricular ejection fraction 19.2% ± 7.0%; QRS duration 165.6 ± 20 ms; LVM 313.9 ± 108.8 g) were enrolled and followed up for a median of 90 months (interquartile range 44–158 months). Thirty-five patients (29.6%) received appropriate shocks or antitachycardia pacing at a median of 73.5 months (interquartile range 25–130 months) postimplantation. Males had a higher VA incidence (male patients 18 of 47 [38.3%] vs female patients 17 of 71 [23.9%]; P = .02). Baseline LVM > 308.9 g separated patients with higher VA risk (P = .001). Less than a 20% decrease in LVM increased VA risk (P < .001). Baseline LVM was the only baseline characteristic predicting VA events in the Cox regression model (hazard ratio 1.01; 95% confidence interval 1.001–1.009; log-rank, P = .003). Sex differences in VA risk were eliminated by the baseline LVM parameters.
Conclusion
VA risk after CRT implantation in nonischemic cardiomyopathy was associated with baseline LV > 308.9 g and a decrease in LVM ≤ 20%, without sex differences.
期刊介绍：
HeartRhythm, the official Journal of the Heart Rhythm Society and the Cardiac Electrophysiology Society, is a unique journal for fundamental discovery and clinical applicability.
HeartRhythm integrates the entire cardiac electrophysiology (EP) community from basic and clinical academic researchers, private practitioners, engineers, allied professionals, industry, and trainees, all of whom are vital and interdependent members of our EP community.
The Heart Rhythm Society is the international leader in science, education, and advocacy for cardiac arrhythmia professionals and patients, and the primary information resource on heart rhythm disorders. Its mission is to improve the care of patients by promoting research, education, and optimal health care policies and standards.
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