背景:室性早搏(PVC)是心力衰竭的潜在可逆原因。然而,最可能出现左心室功能受损的患者的特征尚不清楚.因此,本研究的目的是系统评估PVC诱发心肌病的危险因素.
方法:我们对科学文献进行了结构化数据库搜索,以研究PVC诱发心肌病(PVC-CM)发展的危险因素。我们调查了PVC-CM危险因素(RF)的报告,并使用随机效应荟萃分析评估了不同RF的比较相关性。
结果:共分析了26项研究(9项前瞻性研究和17项回顾性研究),涉及16,764,641名患者(平均年龄55岁,58%的女性,平均聚氯乙烯负担17%)。11个RF适用于定量分析(多变量模型中≥3次,评估左心室(LV)功能的二元变化)。其中,年龄(每增加1.02岁,95%CI[1.01,1.02]),症状的存在(OR0.18,95%CI[0.05,0.64]),非持续性室性心动过速(VT)(OR3.01,95%CI[1.39,6.50]),LV起源(OR2.20,95%CI[1.14,4.23]),心外膜起源(OR4.72,95%CI[1.81,12.34]),存在插值(OR4.93,95%CI[1.66,14.69]),PVC持续时间(QRS-PVC持续时间每毫秒增加1.05或[1.004;1.096]),PVC负荷(OR1.06,95%CI[1.04,1.08])均与PVC-CM显著相关。
结论:在本荟萃分析中,PVC-CM最一致的风险因素是年龄,非持续性室性心动过速,LV,心外膜起源,插值,和PVC负担,而症状的存在显着降低了风险。这些发现有助于对表现为频繁PVCs和正常LV功能的患者进行严格的随访。
BACKGROUND: Premature ventricular complexes (PVCs) are a potentially reversible cause of heart failure. However, the characteristics of patients most likely to develop impaired left ventricular function are unclear. Hence, the objective of this study is to systematically assess risk factors for the development of PVC-induced cardiomyopathy.
METHODS: We performed a structured database search of the scientific literature for studies investigating risk factors for the development of PVC-induced cardiomyopathy (PVC-CM). We investigated the reporting of PVC-CM risk factors (RF) and assessed the comparative association of the different RF using random-effect meta-analysis.
RESULTS: A total of 26 studies (9 prospective and 17 retrospective studies) involving 16,764,641 patients were analyzed (mean age 55 years, 58% women, mean PVC burden 17%). Eleven RF were suitable for quantitative analysis (≥ 3 occurrences in multivariable model assessing a binary change in left ventricular (LV) function). Among these, age (OR 1.02 per increase in the year of age, 95% CI [1.01, 1.02]), the presence of symptoms (OR 0.18, 95% CI [0.05, 0.64]), non-sustained ventricular tachycardias (VT) (OR 3.01, 95% CI [1.39, 6.50]), LV origin (OR 2.20, 95% CI [1.14, 4.23]), epicardial origin (OR 4.72, 95% CI [1.81, 12.34]), the presence of interpolation (OR 4.93, 95% CI [1.66, 14.69]), PVC duration (OR 1.05 per ms increase in QRS-PVC duration [1.004; 1.096]), and PVC burden (OR 1.06, 95% CI [1.04, 1.08]) were all significantly associated with PVC-CM.
CONCLUSIONS: In this meta-analysis, the most consistent risk factors for PVC-CM were age, non-sustained VT, LV, epicardial origin, interpolation, and PVC burden, whereas the presence of symptoms significantly reduced the risk. These findings help tailor stringent follow-up of patients presenting with frequent PVCs and normal LV function.