摘要
目的:探讨埋藏式心律转复除颤器(ICD)的除颤电极在右心室不同植入位置与三尖瓣反流进展的相关性。方法:回顾性纳入2016年1月至2019年12月于中国医学科学院阜外医院心律失常中心植入ICD或心脏再同步治疗除颤器(CRT-D)患者198例。所有患者在术前及术后均完善超声心动图,根据三尖瓣反流面积分为无、轻、中、重度四级。术后三尖瓣反流进展定义为:随访超声心动图评估的三尖瓣反流程度较术前基线提高至少一个等级。按除颤电极植入部位分为间隔部电极组和心尖部电极组。采用Kaplan-Meier曲线生存分析及Cox比例风险模型评估除颤电极植入部位对于三尖瓣反流进展是否存在影响。结果:198例患者平均年龄(57.1±12.1)岁,其中125例患者植入ICD,73例患者植入CRT-D。间隔部电极组115例(58.1%),心尖部电极组83例(41.9%),基线存在中-重度三尖瓣反流的患者共28例(14.1%)。中位随访12(9,16)个月,共有48例(24.2%)患者出现三尖瓣反流进展,其中间隔部电极组28例(24.3%),心尖部电极组20例(24.1%),两组发生率差异无统计学意义(P=0.97)。进一步分析显示,24例(12.1%)患者在随访期间进展为中-重度三尖瓣反流,其中间隔部电极组16例(13.9%),心尖部电极组8例(9.6%),两组发生率差异无统计学意义(P=0.36)。同时,两组患者随访时的三尖瓣舒张期流速和三尖瓣舒张期跨瓣压差的差异均无统计学意义(P均>0.05)。Kaplan-Meier曲线生存分析显示两组三尖瓣反流进展发生率差异无统计学意义(log-rank P=0.141)。多因素Cox回归分析提示,除颤电极植入间隔部并未增加三尖瓣反流进展的发生风险(HR=0.55,95%CI:0.29~1.02,P=0.07)。结论:ICD除颤电极的植入位置与术后三尖瓣反流进展可能并不相关。
Objectives:To investigate the effect of implantable cardioverter-defibrillator(ICD)lead position on the progress of tricuspid regurgitation(TR).Methods:Patients undergoing ICD or cardiac resynchronization treatment-defibrillator(CRT-D)from January 2016 to December 2019 in the arrhythmia center of Fuwai Hospital were retrospectively enrolled in this study.Echocardiography was performed in all patients at the baseline and after the device implantation.Degree of TR was categorized as none,mild,moderate,and severe,according to the regurgitation bundle area.Progression of TR was defined as an increase of TR by at least 1 grade compared with baseline echocardiography.Patients were divided into septal or apical region group according to lead position.Kaplan-Meier curve analysis and Cox proportional hazards models were performed to evaluate whether ICD lead position was independently associated with TR progression.Results:A total of 198 patients(mean age:[57.1±12.1]years)were included.ICD was implanted in 125 patients and 73 patients received CRT-D.Defibrillation leads were placed in the septal region in 58.1%(115/198)of patients and the apical region in 41.9%(83/198)of patients.At baseline,14.1%(28/198)of patients were diagnosed with moderate or severe TR.During a median follow-up of 12(9,16)months,progression of TR was detected in 24.2%(48/198)patients.Prevalence of progression of TR was similar between the apical region and septal region(24.1%vs.24.3%,P=0.97)group.Twenty-four patients suffered from moderate or severe TR during follow-up,with the defibrillation lead located in the apical region in eight patients and the septal region in 16 patients(9.6%vs.13.9%,P=0.36).Diastolic flow rate or transvalvular pressure gradient of tricuspid valve were also similar between the two groups(both P>0.05).Kaplan-Meier curve analysis also showed similar progression of TR in the two groups.Multivariate Cox regression analyses showed that lead implanted in the septum was not an independent risk factor of TR progression(HR=0.55,95%C
作者
王世栋
王钊
朱浩杰
刘志敏
樊晓寒
WANG Shidong;WANG Zhao;ZHU Haojie;LIU Zhimin;FAN Xiaohan(Arrhythmia Center,National Center for Cardiovascular Diseases and Fuwai Hospital,CAMS and PUMC,Beijing(100037),China)
出处
《中国循环杂志》
CSCD
北大核心
2022年第2期142-147,共6页
Chinese Circulation Journal
关键词
除颤电极
三尖瓣反流
电极位置
心尖部
间隔部
defibrillation electrode
tricuspid regurgitation
lead location
apical region
septal region
