在接受心脏再同步化疗法并改善左室射血分数的患者中,B 型钠利尿肽水平升高是室性心律失常的残留风险因素。

Circulation reports Pub Date : 2024-09-14 eCollection Date: 2024-10-10 DOI:10.1253/circrep.CR-24-0065
Junichi Kamoshida, Nobuhiko Ueda, Kohei Ishibashi, Takashi Noda, Takanori Kawabata, Satoshi Oka, Yuichiro Miyazaki, Akinori Wakamiya, Kenzaburo Nakajima, Tsukasa Kamakura, Mitsuru Wada, Yuko Inoue, Koji Miyamoto, Satoshi Nagase, Takeshi Aiba, Hideaki Kanzaki, Chisato Izumi, Teruo Noguchi, Kengo Kusano
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引用次数: 0

摘要

背景:通过心脏再同步化疗法(CRT)改善左室射血分数(LVEF >35%)的患者发生室性心律失常(VA)的风险较低。人们对 B 型钠尿肽(BNP)水平对 VA 风险的意义知之甚少。本研究调查了 CRT 中 VA 的风险因素,以及在 LVEF 改善的 CRT 中用 BNP 对 VA 进行风险分层:本研究评估了 2012 年至 2020 年间的 352 例 CRT 患者。患者分为两组:LVEF改善组(impEF; LVEF >35%)和LVEF低组(lowEF; LVEF ≤35%)。CRT装置植入6个月后,测量血清BNP水平。主要终点定义为需要抗心动过速起搏或电击治疗或持续时间≥30 秒的 VA。IMPEF组的VA风险明显低于低EF组。低BNP患者的VA风险低于高BNP患者;但高BNP患者与低EF组患者之间没有明显差异。单变量分析显示,高 BNP 是 impEF 组 VA 的预测因子:结论:CRT后LVEF改善可降低VA风险,但BNP水平过高不会降低VA风险。植入 CRT 后的 BNP 水平是预测 LVEF 改善患者 VA 的有效指标。
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Elevated B-Type Natriuretic Peptide Level as a Residual Risk Factor for Ventricular Arrhythmias Among Patients Undergoing Cardiac Resynchronization Therapy With Improved Left Ventricular Ejection Fraction.

Background: Patients who achieve improved left ventricular ejection fraction (LVEF >35%) with cardiac resynchronization therapy (CRT) are at a lower risk of ventricular arrhythmia (VA). Little is known about the significance of the B-type natriuretic peptide (BNP) level for the risk of VA. This study investigated the risk factors for VA in CRT and the risk stratification of VA with BNP in CRT with improved LVEF.

Methods and results: This study evaluated 352 CRT patients from 2012 to 2020. Patients were categorized into 2 groups: improved LVEF (impEF; LVEF >35%), and low LVEF (lowEF; LVEF ≤35%). The serum BNP levels 6 months after CRT device implantation were measured. The primary endpoint was defined as VA requiring treatment with anti-tachycardia pacing or shock or persisting for ≥30 s. Overall, 102 patients had improved LVEF. The impEF group had a significantly lower VA risk than the lowEF group. Patients with low BNP had a lower VA risk than those with high BNP; however, no significant difference was observed between patients with high BNP and those in the lowEF group. Univariate analysis revealed that high BNP was a predictor of VA in the impEF group.

Conclusions: The VA risk is reduced with improved LVEF after CRT but not with high BNP levels. The post-BNP level after CRT implantation is a useful marker for predicting VA in patients with improved LVEF.

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