埋藏式心脏复律除颤器在肥厚型心肌病心脏性猝死高危患者一级预防中的临床疗效分析
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摘要
目的:总结分析国内肥厚型心肌病(HCM)心脏性猝死(SCD)高危患者一级预防植入埋藏式心脏复律除颤器(ICD)的有效性和安全性。方法:连续入选2011年1月至2017年12月在阜外医院植入ICD作为一级预防的HCM SCD高危患者,对ICD恰当治疗、不恰当治疗及ICD植入相关并发症进行回顾性分析。结果:共纳入38例HCM SCD高危患者,平均年龄(52.1±16.3)岁,其中男性25例(65.8%)。平均随访(29.3±24.2)个月,14例(36.8%)患者接受≥1次的ICD恰当治疗,ICD恰当治疗率为13.3%/年。多因素COX回归分析显示,SCD家族史(HR=11.8,95%CI:1.3～107.5,P=0.029)为ICD恰当治疗的独立预测因子。随访期间4例(10.5%)患者接受ICD不恰当治疗。2例(5.3%)患者发生ICD植入相关并发症,随访期间无死亡事件发生。结论:HCM SCD高危患者一级预防植入ICD恰当治疗率高,ICD不恰当治疗率和植入相关并发症发生率低,SCD家族史是ICD恰当治疗的独立预测因子。
Objectives: To analyze the efficacy and safety of primary prevention implantable cardioverter defibrillators(ICD) for sudden cardiac death(SCD) in patients with hypertrophic cardiomyopathy(HCM).Methods: Clinical data of HCM patients who received primary prevention ICDs in Fuwai Hospital from January 2011 to December 2017 were retrospectively analyzed. Results: Thirty-eight consecutive patients(mean age: [52.1±16.3] years, 25 males [65.8%]) were included in this study. and the average ICD implanted age was(2.1±16.3) years. Over a mean follow-up period of(29.3±24.2) months, ICD provided appropriate therapy in 14 patients(36.8%), the appropriate ICD therapy rate was 13.3%/year. Multiple Cox regression analysis showed that family history of SCD(HR=11.8, 95%CI: 1.3-107.5, P=0.029) was the independent predictor for appropriate therapy. Inappropriate therapy occurred in 4 patients(10.5%). Two patients(5.3%) experienced complications associated with ICD implantation. There was no death during the follow-up period. Conclusions: These data indicate that the rate of appropriate ICD therapy for primary prevention in HCM is high. The frequencies of inappropriate ICD therapy and complications are low. Family history of SCD is the independent predictor for appropriate therapy of primary prevention ICD.
Objectives: To analyze the efficacy and safety of primary prevention implantable cardioverter defibrillators(ICD) for sudden cardiac death(SCD) in patients with hypertrophic cardiomyopathy(HCM).Methods: Clinical data of HCM patients who received primary prevention ICDs in Fuwai Hospital from January 2011 to December 2017 were retrospectively analyzed. Results: Thirty-eight consecutive patients(mean age: [52.1±16.3] years, 25 males [65.8%]) were included in this study. and the average ICD implanted age was(2.1±16.3) years. Over a mean follow-up period of(29.3±24.2) months, ICD provided appropriate therapy in 14 patients(36.8%), the appropriate ICD therapy rate was 13.3%/year. Multiple Cox regression analysis showed that family history of SCD(HR=11.8, 95%CI: 1.3-107.5, P=0.029) was the independent predictor for appropriate therapy. Inappropriate therapy occurred in 4 patients(10.5%). Two patients(5.3%) experienced complications associated with ICD implantation. There was no death during the follow-up period. Conclusions: These data indicate that the rate of appropriate ICD therapy for primary prevention in HCM is high. The frequencies of inappropriate ICD therapy and complications are low. Family history of SCD is the independent predictor for appropriate therapy of primary prevention ICD.
引文
[1] Geske JB, Ommen SR, Gersh BJ. Hypertrophic cardiomyopathy:clinical update[J]. JACC Heart Fail, 2018, 6(5):364-375. DOI:10.1016/j.jchf. 2018. 02.010.
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[3] Schinkel AF,Vriesendorp PA,Sijbrands EJ,et al. Outcome and complications after implantable cardioverter defibrillator therapy in hypertrophic cardiomyopathy:systematic review and metaanalysis[J]. Circ Heart Fail, 2012, 5(5):552-559. DOI:10. 1161/CIRCHEARTFAILURE. 112. 969626.
[4] Maron BJ, Spirito P, Shen WK, et al. Implantable cardioverterdefibrillators and prevention of sudden cardiac death in hypertrophic cardiomyopathy[J]. JAMA, 2007, 298(4):405-412. DOI:10. 1001/jama. 298. 4. 405.
[5] Thavikulwat AC, Tomson TT, Knight BP, et al. Appropriate implantable defibrillator therapy in adults with hypertrophic cardiomyopathy[J]. J Cardiovasc Electrophysiol, 2016, 27(8):953-960. DOI:10. 1111/jce. 13005.
[6] Maron BJ, Maron MS. Contemporary strategies for risk stratification and prevention of sudden death with the implantable defibrillator in hypertrophic cardiomyopathy[J]. Heart Rhythm, 2016, 13(5):1155-1165. DOI:10. 1016/j. hrthm. 2015. 12. 048.
[7] Elliott PM, Anastasakis A, Borger MA, et al. 2014 ESC Guidelines on diagnosis and management of hypertrophic cardiomyopathy:the Task Force for the Diagnosis and Management of HypertrophicCardiomyopathy of the European Society of Cardiology(ESC)[J].Eur Heart J, 2014, 35(39):2733-2779. DOI:10. 1093/eurheartj/ehu284.
[8]中华医学会心血管病学分会,中国成人肥厚型心肌病诊断与治疗指南编写组,中华心血管病杂志编辑委员会.中国成人肥厚型心断肌病诊断与治疗指南[J].中华心血管病杂志,2017,45(12):1015-1032. DOI:10. 3760/cma. j. issn. 0253-3758. 2017. 12. 005.
[9] American College of Cardiology Foundation/American Heart Association Task Force on Practice, American Association for Thoracic Surgery, American Society of Echocardiography, et al.2011 ACCF/AHA guideline for the diagnosis and treatment of hypertrophic cardiomyopathy:a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines[J]. J Thorac Cardiovasc Surg, 2011, 142(6):e153-203.DOI:10. 1016/j. jtcvs. 2011. 10. 020.
[10] Maron BJ, Spirito P, Ackerman MJ, et al. Prevention of sudden cardiac death with implantable cardioverter-defibrillators in children and adolescents with hypertrophic cardiomyopathy[J]. J Am Coll Cardiol, 2013, 61(14):1527-1535. DOI:10. 1016/j. jacc. 2013. 01.037.
[11] Spirito P, Autore C, Rapezzi C, et al. Syncope and risk of sudden death in hypertrophic cardiomyopathy[J]. Circulation, 2009, 119(13):1703-1710. DOI:10. 1161/CIRCULATIONAHA. 108.798314.
[12] Elliott PM, Poloniecki J, Dickie S, et al. Sudden death in hypertrophic cardiomyopathy:identification of high risk patients[J].J Am Coll Cardiol, 2000, 36(7):2212-2218.
[13] O'mahony C, Jichi F, Pavlou M, et al. A novel clinical risk prediction model for sudden cardiac death in hypertrophic cardiomyopathy(HCM risk-SCD)[J]. Eur Heart J, 2014, 35(30):2010-2020. DOI:10.1093/eurheartj/eht439.
[14] Wang N, Xie A, Tjahjono R, et al. Implantable cardioverter defibrillator therapy in hypertrophic cardiomyopathy:an updated systematic review and meta-analysis of outcomes andcomplications[J]. Ann Cardiothorac Surg, 2017, 6(4):298-306. DOI:10. 21037/acs. 2017. 07. 05.
[15] Braunschweig F, Boriani G, Bauer A, et al. Management of patients receiving implantable cardiac defibrillator shocks:recommendations for acute and long-term patient management[J]. Europace, 2010,12(12):1673-1690. DOI:10. 1093/europace/euq316.
[16] Trivedi A, Knight BP. ICD therapy for primary prevention in hypertrophic cardiomyopathy[J]. Arrhythm Electrophysiol Rev,2016, 5(3):188-196. DOI:10. 15420/aer. 2016:30:2.
[17] Vriesendorp PA, Schinkel AF, Liebregts M, et al. Validation of the2014 European Society of Cardiology guidelines risk prediction model for the primary prevention of sudden cardiac death in hypertrophic cardiomyopathy[J]. Circ Arrhythm Electrophysiol,2015, 8(4):829-835. DOI:10. 1161/CIRCEP. 114. 002553.
[18] Maron BJ, Casey SA, Chan RH, et al. Independent assessment of the European society of cardiology sudden death risk model for hypertrophic cardiomyopathy[J]. Am J Cardiol, 2015, 116(5):757-764. DOI:10. 1016/j. amjcard. 2015. 05. 047.
[19] Weissler-Snir A, Adler A, Williams L, et al. Prevention of sudden death in hypertrophic cardiomyopathy:bridging the gaps in knowledge[J]. Eur Heart J, 2017, 38(22):1728-1737. DOI:10.1093/eurheartj/ehw268.
[20]姚焰.我国心原性猝死的放置水平亟待提高[J].中国循环杂志,2017,33(2):105-106. DOI:10.3969/j.issn.1000-3614.2018.02.001.
[21]闫丽荣,陈柯萍,戴研,等.植人型心律转复除颤器在肥厚型心肌病患者中的临床有效性和安全性研究[J].中华心律失常学杂志,2018, 22(5):402-407. DOI:10.3760/cma.j.issn.1007-6638.2018.05.007.
[22]戴研,陈柯萍,华伟,等.植人型心律转复除颤器临床应用现状(20家医院注册研究)[J].中华心律失常学杂志,2017, 21(1):26-30.DOI:10.3760/cma.j.issn.1007-6638.2017.01.006.
[2]安硕研,蔡迟,段福建,等.左心室中部肥厚型梗阻性心肌病与心尖肥厚型心肌病患者的临床特点及长期预后比较[J].中华心血管病杂志.2015, 43(10):874-878. DOI:10. 3969/j. issn. 1000-3614.2015. 11.006.
[3] Schinkel AF,Vriesendorp PA,Sijbrands EJ,et al. Outcome and complications after implantable cardioverter defibrillator therapy in hypertrophic cardiomyopathy:systematic review and metaanalysis[J]. Circ Heart Fail, 2012, 5(5):552-559. DOI:10. 1161/CIRCHEARTFAILURE. 112. 969626.
[4] Maron BJ, Spirito P, Shen WK, et al. Implantable cardioverterdefibrillators and prevention of sudden cardiac death in hypertrophic cardiomyopathy[J]. JAMA, 2007, 298(4):405-412. DOI:10. 1001/jama. 298. 4. 405.
[5] Thavikulwat AC, Tomson TT, Knight BP, et al. Appropriate implantable defibrillator therapy in adults with hypertrophic cardiomyopathy[J]. J Cardiovasc Electrophysiol, 2016, 27(8):953-960. DOI:10. 1111/jce. 13005.
[6] Maron BJ, Maron MS. Contemporary strategies for risk stratification and prevention of sudden death with the implantable defibrillator in hypertrophic cardiomyopathy[J]. Heart Rhythm, 2016, 13(5):1155-1165. DOI:10. 1016/j. hrthm. 2015. 12. 048.
[7] Elliott PM, Anastasakis A, Borger MA, et al. 2014 ESC Guidelines on diagnosis and management of hypertrophic cardiomyopathy:the Task Force for the Diagnosis and Management of HypertrophicCardiomyopathy of the European Society of Cardiology(ESC)[J].Eur Heart J, 2014, 35(39):2733-2779. DOI:10. 1093/eurheartj/ehu284.
[8]中华医学会心血管病学分会,中国成人肥厚型心肌病诊断与治疗指南编写组,中华心血管病杂志编辑委员会.中国成人肥厚型心断肌病诊断与治疗指南[J].中华心血管病杂志,2017,45(12):1015-1032. DOI:10. 3760/cma. j. issn. 0253-3758. 2017. 12. 005.
[9] American College of Cardiology Foundation/American Heart Association Task Force on Practice, American Association for Thoracic Surgery, American Society of Echocardiography, et al.2011 ACCF/AHA guideline for the diagnosis and treatment of hypertrophic cardiomyopathy:a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines[J]. J Thorac Cardiovasc Surg, 2011, 142(6):e153-203.DOI:10. 1016/j. jtcvs. 2011. 10. 020.
[10] Maron BJ, Spirito P, Ackerman MJ, et al. Prevention of sudden cardiac death with implantable cardioverter-defibrillators in children and adolescents with hypertrophic cardiomyopathy[J]. J Am Coll Cardiol, 2013, 61(14):1527-1535. DOI:10. 1016/j. jacc. 2013. 01.037.
[11] Spirito P, Autore C, Rapezzi C, et al. Syncope and risk of sudden death in hypertrophic cardiomyopathy[J]. Circulation, 2009, 119(13):1703-1710. DOI:10. 1161/CIRCULATIONAHA. 108.798314.
[12] Elliott PM, Poloniecki J, Dickie S, et al. Sudden death in hypertrophic cardiomyopathy:identification of high risk patients[J].J Am Coll Cardiol, 2000, 36(7):2212-2218.
[13] O'mahony C, Jichi F, Pavlou M, et al. A novel clinical risk prediction model for sudden cardiac death in hypertrophic cardiomyopathy(HCM risk-SCD)[J]. Eur Heart J, 2014, 35(30):2010-2020. DOI:10.1093/eurheartj/eht439.
[14] Wang N, Xie A, Tjahjono R, et al. Implantable cardioverter defibrillator therapy in hypertrophic cardiomyopathy:an updated systematic review and meta-analysis of outcomes andcomplications[J]. Ann Cardiothorac Surg, 2017, 6(4):298-306. DOI:10. 21037/acs. 2017. 07. 05.
[15] Braunschweig F, Boriani G, Bauer A, et al. Management of patients receiving implantable cardiac defibrillator shocks:recommendations for acute and long-term patient management[J]. Europace, 2010,12(12):1673-1690. DOI:10. 1093/europace/euq316.
[16] Trivedi A, Knight BP. ICD therapy for primary prevention in hypertrophic cardiomyopathy[J]. Arrhythm Electrophysiol Rev,2016, 5(3):188-196. DOI:10. 15420/aer. 2016:30:2.
[17] Vriesendorp PA, Schinkel AF, Liebregts M, et al. Validation of the2014 European Society of Cardiology guidelines risk prediction model for the primary prevention of sudden cardiac death in hypertrophic cardiomyopathy[J]. Circ Arrhythm Electrophysiol,2015, 8(4):829-835. DOI:10. 1161/CIRCEP. 114. 002553.
[18] Maron BJ, Casey SA, Chan RH, et al. Independent assessment of the European society of cardiology sudden death risk model for hypertrophic cardiomyopathy[J]. Am J Cardiol, 2015, 116(5):757-764. DOI:10. 1016/j. amjcard. 2015. 05. 047.
[19] Weissler-Snir A, Adler A, Williams L, et al. Prevention of sudden death in hypertrophic cardiomyopathy:bridging the gaps in knowledge[J]. Eur Heart J, 2017, 38(22):1728-1737. DOI:10.1093/eurheartj/ehw268.
[20]姚焰.我国心原性猝死的放置水平亟待提高[J].中国循环杂志,2017,33(2):105-106. DOI:10.3969/j.issn.1000-3614.2018.02.001.
[21]闫丽荣,陈柯萍,戴研,等.植人型心律转复除颤器在肥厚型心肌病患者中的临床有效性和安全性研究[J].中华心律失常学杂志,2018, 22(5):402-407. DOI:10.3760/cma.j.issn.1007-6638.2018.05.007.
[22]戴研,陈柯萍,华伟,等.植人型心律转复除颤器临床应用现状(20家医院注册研究)[J].中华心律失常学杂志,2017, 21(1):26-30.DOI:10.3760/cma.j.issn.1007-6638.2017.01.006.