所属 医学部 医学科（東京女子医科大学病院） 職種 特任准教授
|発表タイトル||Short-term prevalence of fatal ventricular arrhythmic events in patients with newly diagnosed reduced left ventricular ejection fraction|
|会議名||ESC CONGRESS 2017|
|主催者||European Society of Cardiology|
|発表者・共同発表者||◎KIKUCHI Noriko, SHIGA Tsuyoshi, MINAMI Yoshiaki, SUZUKI Atsushi, NOMURA Arata, SERIZAWA Naoki, EJIMA Koichiro, SHODA Morio, HAGIWARA Nobuhisa|
|概要||Background: Patients with heart failure (HF) who have reduced left ventricular ejection fraction (LVEF) are at a high risk of sudden cardiac death (SCD). Although many of these patients become candidates for implantable cardioverter defibrillator, the decision should be made carefully because of complications such as infections, inappropriate shock. Some patients experience a significant improvement in LVEF during follow-up. Patients with newly diagnosed reduced LVEF were made to use the wearable cardioverter-defibrillator (WCD) for 3 months to protect them from SCD until reevaluation of their LVEF.
Purpose: The aim of this study was to assess the short-term prevalence of fatal ventricular arrhythmic events in patients with newly diagnosed reduced LVEF, to determine the recovery rate of LVEF after discharge, and to identify the predictive factors of recovery.
Methods: For this study, 184 consecutive patients with HF who were admitted in our department between January 2014 and April 2016 and found to have reduced LVEF (<35%) for the first time were evaluated retrospectively. We investigated the prevalence of fatal ventricular arrhythmic events at 3 months after discharge.
Results: The mean age of the patients was 63.5 years, and 71.7% of the patients were male. The mean left ventricular EF, measured by using echocardiography, was 28.4%. Of the patients, 70% were diagnosed as having non-ischemic cardiomyopathy. All the patients received optimal therapies such as medical therapy that included angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs) and beta-blockers, coronary intervention, catheter ablation. Fifteen patients (8.2%) died in the hospital. At 3 months after discharge, 5 patients (2.7%) experienced fatal arrhythmic events, including SCD. Four (80%) of them had atrial fibrillation (AF). For pharmacotherapy, all 5 patients received loop diuretics and beta-blockers, but the amount of the beta-blockers administered were very small for reasons such as hypotension, bradycardia and intolerance. Moreover, in about 50% of the patients, the LVEF recovered by >35% (mean LVEF, 37.0%) at about 6 months after discharge. The patients who did not recover had significantly lower LVEF (26.6% vs. 29.5%, p=0.013), longer QRS width at admission (120ms vs. 104ms, p=0.013), and lower proportion of AF rhythm on admission (17% vs. 35%, p=0.016) than those who recovered.
Conclusions: Among the patients with newly diagnosed reduced LVEF, 2.7% had a SCD within a short period after discharge. Further research is needed to establish the optimal use of WCD.