Статья
Роль внутрисердечного электрофизиологического исследования в стратификации риска желудочковых тахиаритмий у больных хронической сердечной недостаточностью со сниженной фракцией выброса левого желудочка неишемического генеза
Был проведен систематический обзор и мета-анализ исследований, предоставляющих информацию о возможностях применения внутрисердечного электрофизиологического исследования (ЭФИ) для стратификации риска желудочковых тахиаритмий (ЖТ) у больных хронической сердечной недостаточностью с низкой фракцией выброса левого желудочка (ХСНнФВ) неишемического генеза. Поиск релевантных публикаций производился до 20.01.2021 г. двумя независимыми исследователями в крупных поисковых системах, электронных архивах клинических исследований, репозитории препринтов открытого доступа. В качестве конечной точки рассматривался эпизод внезапной сердечной смерти или устойчивый пароксизм ЖТ, либо обоснованная электротерапия имплантированного кардиовертера-дефибриллятора. Отобрано 10 клинических исследований, включавших 608 релевантных больных (средний возраст: 51,5±12 лет, средняя ФВ ЛЖ: 26,8±8,5%, ХСН по NYHA ФК: I - 17,7%; II - 33,7%; III - 35,9%, IV - 12,7%). Конечная точка была зарегистрирована у 92 больных (15,1%): у 47 пациентов (43,9%) с ранее индуцированными ЖТ в ходе ЭФИ и у 45 пациентов (8,9%) без ЖТ. Отношение диагностических шансов оказалось равным 5,57 (2,27-13,63). Суммарная чувствительность и специфичность ЭФИ составили 42% (26-61%) и 88% (83-92%) соответственно. Полученные результаты указывают на возможность использования ЭФИ для стратификации аритмического риска у больных ХСНнФВ неишемического генеза.
1. Ponikowski P, Anker SD, AlHabib KF, et al. Heart failure: preventing disease and death worldwide. ESC Heart Fail. 2014;1: 4-25. https://doi:10.1002/ehf2.12005.
2. Мареев ЮB, Фомин ИB, Агеев ФТ, и др. Клинические рекомендации ОCCН-PКО-PНМОТ. Ceрдeчнaя недостаточность: хроническая (XCH) и острая декомпенсированная (ОДCН). Диагностика, профилактика и лечения. Кардиология. 2018;58(6S): 8-164 https://doi:10.18087/cardio.2475.
3. Vaduganathan M, Patel RB, Michel A, et al. Mode of Death in Heart Failure With Preserved Ejection Fraction. J Am Coll Cardiol. 2017;69(5): 556-569. https://doi:10.1016/j.jacc.2016.10.078.
4. Packer M. What causes sudden death in patients with chronic heart failure and a reduced ejection fraction? Eur Heart J. 2020;41: 1757-63. https://doi.org/10.1093/eurheartj/ehz553.
5. Chung FP, Lin CY, Lin YJ, et al. Ventricular arrhythmias in nonischemic cardiomyopathy. J Arrhythmia. 2018;34: 336-46. https://doi:10.1002/joa3.12028.
6. Zaman S, Goldberger JJ, Kovoor P. Sudden Death Risk-Stratification in 2018-2019: The Old and the New. Hear Lung Circ. 2019;28: 57-64. https://doi.org/10.1016/j.hlc.2018.08.027.
7. Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail. 2016;18(8): 891-975. https://doi:10.1002/ejhf.592.
8. Al-Khatib SM, Stevenson WG, Ackerman MJ, et al. 2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: Executive Summary. Circulation. 2018;138(13) :e210-e271. https://doi:10.1161/CIR.0000000000000548.
9. Amara N, Boveda S, Defaye P, et al. Implantable cardioverter-defibrillator therapy among patients with non-ischaemic vs. ischaemic cardiomyopathy for primary prevention of sudden cardiac death. EP Europace. 2017;20: 65-72. https://doi.org/10.1093/europace/euw379.
10. Meng F, Zhang Z, Hou X, et al. Machine learning for prediction of sudden cardiac death in heart failure patients with low left ventricular ejection fraction: study protocol for a retroprospective multicentre registry in China. BMJ Open. 2019;9: e023724. https://doi.org/10.1136/bmjop-en-2018-023724.
11. Hashimoto K, Amino M, Yoshioka K, et al. Combined evaluation of ambulatory-based late potentials and nonsustained ventricular tachycardia to predict arrhythmic events in patients with previous myocardial infarction: A Japanese noninvasive electrocardiographic risk stratification of sudden cardiac death (JANIES) substudy. Ann Non-invasive Electrocardiol. 2020: 1-11. https://doi:10.1111/anec.12803.
12. Голухова ЕЗ, Громова ОИ, Булаева НИ, и др. Bнeзапная сердечная смерть у больных ишемической болезнью сердца: от механизмов к клинической практике. Кардиология. 2017;57(12):73-81 https://doi:10.18087/cardio.2017.12.10069.
13. Masarone D, Limongelli G, Ammendola E, et al. Risk Stratification of Sudden Cardiac Death in Patients with Heart Failure: An update. J Clin Med. 2018;7: 436. https://doi:10.3390/jcm7110436.
14. Disertori М, Mase М, Ravelli F. Myocardial fibrosis predicts ventricular tachyarrhythmias. Trends in Car-diovasc Med. 2017;27: 363-72. https://doi.org/10.1016/j.tcm.2017.01.011.
15. Илов НН, Пальникова ОB, Отомпель ДР, и др. Отратификация риска внезапной сердечной смерти у пациентов с сердечной недостаточностью: достаточно ли одной фракции выброса левого желудочка? Российский кардиологический журнал. 2021;26(1): 3959 https://doi:10.15829/1560-4071-2021-3959.
16. Adhyapak SM, Parachuri VR. Is programmed electrical stimulation mandatory for recognition of ventricular arrhythmogenicity in heart failure? Indian J Thorac Cardiovasc Surg. 2020;36: 52-5. https://doi.org/10.1007/s12055-019-00839-6.
17. Buxton AE, Lee KL, Dicarlo L, et al. Electrophysiologic testing to identify patients with coronary artery disease who are at risk for sudden death. N Engl J Med. 2000;342: 1937-45. https://doi.org/10.1056/NEJM200006293422602.
18. El-Sherif N, Boutjdir M, Turitto G. Sudden Cardiac Death in Ischemic Heart Disease: Pathophysiology and Risk Stratification. Card Electrophysiol Clin. 2017;9: 68191. https://doi.org/10.1016/j.ccep.2017.08.003.
19. Kumar S, Sivagangabalan G, Zaman S, et al. Electrophysiology-guided defibrillator implantation early after ST-elevation myocardial infarction. Heart Rhythm. 2010;7: 1589-97. doi:10.1016/j.hrthm.2010.07.019.
20. Burke AP, Virmani R. Pathophysiology of Acute Myocardial Infarction. Med Clin of North Am. 2007;91: 553-72. https://doi.org/10.1016/j.mcna.2007.03.005.
21. Poll DS, Marchlinski FE, Buxton AE, et al. Usefulness of programmed stimulation in idiopathic dilated cardiomyopathy. Am J Cardiol. 1986;58: 992-7. https://doi:10.1016/S0002-9149(86)80025-X.
22. Manolis A. The Diminished Role of an Electrophysiology Study in the Current Guidelines for Sudden Cardiac Death. Rhythmos. 2018;13: 1-5.
23. Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol. 2009;62(10): e1-34. https://doi:10.1016/j.jclinepi.2009.06.006.
24. Реброва ОЮ, Федяева BK. Вопросник для оценки риска систематических ошибок в нерандомизированных сравнительных исследованиях : русскоязычная версия шкалы Ньюкасл-Оттава. Медицинские технологии. Оценка и выбор. 2016;14-19
25. DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986;7: 177-88. https://doi.org/10.1016/0197-2456(86)90046-2.
26. Freeman SC, Kerby CR, Patel A, et al. Development of an interactive web-based tool to conduct and interrogate meta-analysis of diagnostic test accuracy studies: MetaD-TA. BMC Med Res Methodol. 2019;19: 1-11. https://doi:10.1186/s12874-019-0724-x.
27. Piers S, Androulakis A, Yim K, et al. Non-sustained ventricular tachycardia in nonischemic dilated cardiomyopathy: results from a nonischemic cardiomyopathy study. EP Europace. 2020;22(1): euaa162.006. https://doi.org/10.1093/europace/euaa162.006.
28. Kadish A, Schmaltz S, Calkins H, et al. Management of Nonsustained Ventricular Tachycardia Guided By Electrophysiological Testing. Pacing Clin Electrophysiol. 1993;16: 1037-50. https://doi:10.1111/j.1540-8159.1993.tb04578.x.
29. Brembilla-Perrot B, Donetti J, Terrier de la Chaise A, et al. Diagnostic value of ventricular stimulation in patients with idiopathic dilated cardiomyopathy. Am Heart J. 1991;121: 1124-31. https://doi:10.1016/0002-8703(91)90672-5.
30. Becker R, Haass M, Ick D, et al. Role of nonsustained ventricular tachycardia and programmed ventricular stimulation for risk stratification in patients with idiopathic dilated cardiomyopathy. Basic Res Cardiol. 2003;98: 259-66. https://doi:10.1007/s00395-003-0398-7.
31. Das SK, Morady F, DiCarlo L, et al. Prognostic usefulness of programmed ventricular stimulation in idiopathic dilated cardiomyopathy without symptomatic ventricular arrhythmias. Am J Cardiol. 1986;58: 998-1000. https://doi:10.1016/S0002-9149(86)80026-1.
32. Grimm W, Hoffmann J, Menz V, et al. Programmed ventricular stimulation for arrhythmia risk prediction in patients with idiopathic dilated cardiomyopathy and nonsustained ventricular tachycardia. J Am Coll Cardiol. 1998;32: 739-45. https://doi:10.1016/S0735-1097(98)00306-4.
33. Gatzoulis KA, Vouliotis AI, Tsiachris D, et al. Primary prevention of sudden cardiac death in a nonischemic dilated cardiomyopathy population reappraisal of the role of programmed ventricular stimulation. Circ Arrhythmia Electrophysiol. 2013;6: 504-12. https://doi:10.1161/CIR-CEP.113.000216.
34. Gossinger HD, Jung M, Wagner L, et al. Prognostic role of inducible ventricular tachycardia in patients with dilated cardiomyopathy and asymptomatic nonsustained ventricular tachycardia. Int J Cardiol. 1990;29: 215-20. https://doi:10.1016/0167-5273(90)90224-S.
35. Kron J, Hart M, Schual-Berke S, et al. Idiopathic dilated cardiomyopathy. Role of programmed electrical stimulation and holter monitoring in predicting those at risk of sudden death. Chest. 1988;93: 85-90. https://doi:10.1378/chest.93.1.85.
36. Turitto G, Ahuja RK, Caref EB, et al. Risk stratification for arrhythmic events in patients with nonischemic dilated cardiomyopathy and nonsustained ventricular tachycardia: Role of programmed ventricular stimulation and the signal-averaged electrocardiogram. J Am Coll Cardiol. 1994;24: 1523-8. https://doi:10.1016/0735-1097(94)90149-X.
37. Pimentel M, Zimerman A, Chemello D, et al. Predictors of serious arrhythmic events in patients with nonischemic heart failure. J Interv Card Electrophysiol. 2017;48: 131-9. https://doi:10.1007/s10840-016-0213-7.
38. Disertori M, Mase M, Rigoni M, et al. Ventricular tachycardia-inducibility predicts arrhythmic events in post-myocardial infarction patients with low ejection fraction. A systematic review and meta-analysis. IJC Hear Vasc. 2018;20: 7-13. https://doi:10.1016/j.ijcha.2018.06.002.
39. Zaman S, Kumar S, Narayan A, et al. Induction of ventricular tachycardia with the fourth extrastimulus and its relationship to risk of arrhythmic events in patients with post-myocardial infarct left ventricular dysfunction. EP Eur. 2012;14: 1771-7. https://doi:10.1093/europace/eus199.
40. Hummel JD, Strickberger SA, Daoud E, et al. Results and efficiency of programmed ventricular stimulation with four extrastimuli compared with one, two, and three extrastimuli. Circulation. 1994;90: 2827-32. https://doi:10.1161/01.CIR.90.6.2827.
41. Reddy CP, Gettes LS. Use of isoproterenol as an aid to electric induction of chronic recurrent ventricular tachycardia. Am J Cardiol. 1979;44: 705-13. https:// doi:10.1016/0002-9149(79)90291-1.
42. Stevenson WG, Kanagasundram A. VT Ablation: It Is Not Always About the Scar* JACC: Clinical Electrophysiology. 2020;6(2): 231-240. https://doi:10.1016/j.ja-cep.2019.09.010.
43. Yokoshiki H, Shimizu A, Mitsuhashi T, et al. Current status and role of programmed ventricular stimulation in patients without sustained ventricular arrhythmias and reduced ejection fraction: Analysis of the Japan cardiac device treatment registry database. J Arrhythmia. 2021;37: 148-56. https://doi:10.1002/joa3.12468.
44. Locati ET. New directions for ambulatory monitoring following 2017 HRS-ISHNE expert consensus. J Electrocardiol. 2017;50: 828-32. https://doi:10.1016/j.jelectrocard.2017.08.009.
45. Stiles MK, Fauchier L, Morillo CA, et al. 2019 HRS/ EHRA/APHRS/LAHRS focused update to 2015 expert consensus statement on optimal implantable cardioverter-defibrillator programming and testing. J Interv Card Electrophysiol. 2020;59: 135-44. https://doi:10.1007/s10840-019-00662-4.
46. Notaristefano F, Ambrosio G. Defibrillator and non-ischaemic dilated cardiomyopathy: A never ending story. Eur Hear Journal. 2019;S21: B5-6. https://doi:10.1093/eurheartj/suz005.
47. Gatzoulis KA, Sideris A, Kanoupakis E, et al. Arrhythmic risk stratification in heart failure: Time for the next step? Ann Noninvasive Electrocardiol. 2017;22: e12430. https://doi:10.1111/anec.12430.
48. Gatzoulis KA, Dilaveris P, Arsenos P, et al. Arrhythmic risk stratification in nonischemic dilated cardiomyopathy: The ReCONSIDER study design - A two-step, multifactorial, electrophysiology-inclusive approach. Hell J Cardiol. 2021;62(2): 169-172. https://doi:10.1016/j.hjc.2020.03.008.
49. Al-Gobari M, Al-Aqeel S, Gueyffier F, et al. Effectiveness of drug interventions to prevent sudden cardiac death in patients with heart failure and reduced ejection fraction: an overview of systematic reviews. BMJ Open. 2018;8(7): e021108. https://doi:10.1136/bmjopen-2017-021108.
50. Stockburger M, Moss AJ, Olshansky B, et al. Time-dependent risk reduction of ventricular tachyarrhythmias in cardiac resynchronization therapy patients: a MADIT-RIT sub-study. Europace. 2015;17: 1085.1-1091. https://doi:10.1093/europace/euv008.