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JACC：NSVT对不同人群的预后预测价值亦不同

2012-11-05 JACC JACC

非持续性室性心动过速NSVT预后预测价值
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　　非持续性室性心动过速（nonsustained ventricular tachycardia，NSVT）定义为连发三个或三个以上的室性异位搏动，且频率超过100次/分，持续时间小于30秒。NSVT在临床上十分常见，然而其对预后的预测价值目前仍不明显，对于部分患者，Holter检查发现NSVT常预示着发生室速和心脏性猝死的几率增加，然而对其他患者却不是这样，据此Katritsis D等最近发表

　　非持续性室性心动过速（nonsustained ventricular tachycardia，NSVT）定义为连发三个或三个以上的室性异位搏动，且频率超过100次/分，持续时间小于30秒。NSVT在临床上十分常见，然而其对预后的预测价值目前仍不明显，对于部分患者，Holter检查发现NSVT常预示着发生室速和心脏性猝死的几率增加，然而对其他患者却不是这样，据此Katritsis D等最近发表了一篇综述，旨在探讨NSVT对不同人群的预后价值。

　　对于无器质性心脏病人群：NSVT可在部分正常人处于静息状态时记录到，虽然Framinham研究数据提示存在NSVT的人群死亡率增加，但是目前对于无器质性心脏病人群静息状态下出现的NSVT是否对预后有预测价值还不明确。然而当在运动时或运动恢复期出现NSVT的无器质性心脏病人群，其未来23年内的心血管死亡率将升高2.5倍。对于存在NSVT职业运动员，当运动时NSVT消失常提示预后良好。

　　对于非ST段抬高型ACS患者，发病48小时后出现NSVT常提示心血管死亡及猝死风险明显增加，特别是当NSVT出现于心肌缺血发作相符时。对于急性ST段抬高型心肌梗死患者，发病13-24小时内出现的NSVT提示预后不佳，而对于既往有心梗病史，且已进行再灌注治疗及服用β-阻滞剂的患者，NSVT在通过左室射血分数等相关因素的校正后并不是增加长期死亡率的独立预测因子。

　　对于肥厚型心肌病患者及多数遗传性离子通道病患者，NSVT提示猝死风险明显升高，而对于缺血性心肌病或非缺陷性心肌病所致的心衰患者，NSVT对预后的预测价值仍不明确，有待进一步研究，对于这类患者合并NSVT无需特殊治疗，治疗基础疾病是重点。

　　总之，NSVT十分常见，可见于正常人，也可见于有严重器质性心脏病患者，其对预后的预测价值随病因不同而不同，随病人的情况不同而不同，且目前还有很多有待研究的内容。NSVT往往不需特殊治疗，以治疗原发疾病为主。

链接：

Katritsis DG, Zareba W, Camm AJ.Nonsustained Ventricular Tachycardia.J Am Coll Cardiol. 2012 Oct 5. pii: S0735-1097(12)04225-8. doi: 10.1016/j.jacc.2011.12.063

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    2013-03-03 花花1366

    #SVT#

    0

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    2013-05-05 hbwxf

    #JACC#

    0

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    2012-11-07 12498568m50暂无昵称

    #ACC#

    0

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    2012-11-07 changjitao2016

    #预测价值#

    0