植入型心电监测仪对60岁以上不明原因晕厥患者的诊断和干预价值研究
Diagnostic and intervention value of implantable cardiac monitor in patients over 60 years of age with unexplained syncope
王睿 1张雁飞 2张宏超 2王佳 3申淑慧 1佟佳宾 2刘俊鹏 2吕游 2种甲 2王志蕾 4金鑫 4孙琳 4高旭 4戴研 5梁静 6李海涛 7邹彤 2杨杰孚2
作者信息
- 1. 北京医院心血管内科国家老年医学中心,北京 100730;北京协和医学院研究生院中国医学科学院,北京 100730
- 2. 北京医院心血管内科国家老年医学中心,北京 100730
- 3. 北京医院心血管内科国家老年医学中心,北京 100730;北京大学医学部第五临床医学院,北京 100730
- 4. 北京医院电生理室,北京 100730
- 5. 中国医学科学院北京协和医学院阜外医院心律失常中心,北京 100037
- 6. 首都医科大学附属北京安贞医院心血管内科,北京 100029
- 7. 北京市普仁医院心血管内科,北京 100062
- 折叠
摘要
目的 探讨植入型心电监测仪在60岁以上不明原因晕厥患者中的诊疗价值.方法 该研究为多中心、前瞻性队列研究,纳入2018年6月至2021年4月于北京医院、阜外医院、北京安贞医院、普仁医院就诊的60岁以上不明原因晕厥患者.依据是否自愿接受植入型心电监测仪植入将入选患者分为植入组和传统随访组.终点事件为入组后再次发作晕厥,以及通过植入型心电监测仪记录的心律失常阳性事件判断或经传统随访检查后明确诊断心原性晕厥.使用Kaplan-Meier生存分析比较两组间心原性晕厥累计诊断率差异.采用多因素Cox回归分析不明原因晕厥患者明确诊断心原性晕厥的独立预测因素.结果 共入选198例不明原因晕厥患者,年龄(72.9±8.25)岁,随访558.0(296.0,877.0)d,男性98例(49.5％).植入组 100例(50.5％),传统随访组98例(49.5％).与传统随访组相比,植入组患者更高龄、更易发生合并症,基线心电图提示一度房室传导阻滞者占比更高,而体重指数更低(P均＜0.05).随访期间植入组共计58例(58.0％)患者的植入型心电监测仪记录到心律失常阳性事件.植入组心原性晕厥诊断率[42.0％(42/100)比4.1％(4/98),P＜0.001]及治疗干预率[37.0％(37/100)比2.0％(2/98),P＜0.001]均高于传统随访组.Kaplan-Meier生存分析显示,与传统随访组相比较,植入组心原性晕厥累计诊断率更高,差异有统计学意义(HR=11.66,95％CI 6.49～20.98,log-rank P＜0.00l).多因素Cox回归分析结果显示,植入型心电监测仪植入、既往心房颤动、糖尿病或基线心电图提示一度房室传导阻滞是不明原因晕厥患者明确诊断心原性晕厥的独立预测因素(P均＜0.05).结论 植入型心电监测仪提高了不明原因晕厥患者的诊断率和干预率,显著增加不明原因晕厥的诊断效率.
Abstract
Objective To investigate the value of implantable cardiac monitor(ICM)in the diagnosis and treatment of patients over 60 years old with unexplained syncope.Methods This was a multi-center,prospective cohort study.Between June 2018 and April 2021,patients over the age of 60 with unexplained syncope at Beijing Hospital,Fuwai Hospital,Beijing Anzhen Hospital and Puren Hospital were enrolled.Patients were divided into 2 groups based on their decision to receive ICM implantation(implantation group and conventional follow-up group).The endpoint was the recurrence of syncope and cardiogenic syncope as determined by positive cardiac arrhythmia events recorded at the ICM or diagnosed during routine follow-up.Kaplan-Meier survival analysis was used to compare the differences of cumulative diagnostic rate between the 2 groups.A multivariate Cox regression analysis was performed to determine independent predictors of diagnosis of cardiogenic syncope in patients with unexplained syncope.Results A total of 198 patients with unexplained syncope,aged(72.9±8.25)years,were followed for 558.0(296.0,877.0)d,including 98 males(49.5％).There were 100(50.5％)patients in the implantation group and 98(49.5％)in the conventional follow-up group.Compared with conventional follow-up group,patients in the implantation group were older,more likely to have comorbidities,had a higher proportion of first degree atrioventricular block indicated by baseline electrocardiogram,and had a lower body mass index(all P＜0.05).During the follow-up period,positive cardiac arrhythmia events were recorded in 58(58.0％)patients in the ICM group.The diagnosis rate(42.0％(42/100)vs.4.1％(4/98),P＜0.001)and the intervention rate(37.0％(37/100)vs.2.0％(2/98),P＜0.001)of cardiogenic syncope in the implantation group were higher than those in the conventional follow-up group(all P＜0.001).Kaplan-Meier survival analysis showed that the cumulative diagnostic rate of cardiogenic syncope was significantly higher in the implantation group than in the traditional follow-up group(HR=11.66,95％CI 6.49-20.98,log-rank P＜0.001).Multivariate analysis indicated that ICM implantation,previous atrial fibrillation,diabetes mellitus or first degree atrioventricular block in baseline electrocardiogram were independent predictors for cardiogenic syncope(all P＜0.05).Conclusions ICM implantation improves the diagnosis and intervention rates in patients with unexplained syncope,and increases diagnostic efficiency in patients with unexplained syncope.
关键词
晕厥/心原性晕厥/植入型心电监测仪/心电描记术/心律失常/病态窦房结综合征/房室传导阻滞/心房颤动Key words
Syncope/Cardiac Syncope/Implantable cardiac monitor/Electrocardiography/Arrhythmia/Sick sinus syndrome/Atrioventricular block/Atrial fibrillation引用本文复制引用
基金项目
北京市科技重大专项(D181100000218005)
出版年
2024
NETL
NSTL
万方数据