Современные предикторы жизнеугрожающих аритмий

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Abstract

In spite of the optimal medication and frequently successful surgical treatment the patients who survived myocardial infarction have higher risk of sudden cardiac death. The basis of fatal arrhythmias in this category of patients has two different electrophysiological variants: acute myocardial ischemia which contributes to its electrical instability and presence of anatomical substrate (most commonly it is a scar after myocardial infarction in past history) which determines the heterogeneity of myocardium. Besides there are following triggers for fatal arrhythmia development: electrolyte, metabolic, neurohumoral disturbances, vegetative dysfunction, drug administration with the impact on conductivity and repolarization (primarily antiarrhythmics). In particularly, combination of trigger factors and exposed myocardium is likely to result in fatal arrhythmias. Searching for factors which are able to detect such "exposed" myocardium and predict the ability of fatal arrhythmia development are the most interesting for clinicians. At present, the implantation of cardioverterdefibrillator in order to prevent sudden cardiac death in such patients is performed according to the single value - left ventricular ejection fraction. International contemporary recommendations (American College of Cardiology Foundation/American Heart Association) show that left ventricular ejection fraction of 35% or less is the main indication for implantation of cardioverter-defibrillator in postinfarction patients. Besides, functional class II or III of New York Heart Association (NYHA) classification and time (not less than 40 days) from the moment of acute event (class I; evidence grade A) are considered to be significant. As a result, according to literature, only one of four implantable devices works out and the vast majority of potential "victims" of sudden death do not receive adequate prophylaxis. A number of additional predictors for detecting possible myocardial substrates of malignant arrhythmias were proposed in order to improve the risk stratification. These are echocardiographic parameters (T-wave alternation, high resolution electrocardiography with calculation of delayed ventricular potentials, duration and dispersion of Q-T interval, tests based on Holter monitoring (variability and turbulence of cardiac rhythm), methods of myocardial visualization (magnetic resonance tomography, computed tomography, tissue Doppler) and different neurohumoral markers. Pathophysiological background and methodological aspects of calculation for each of above mentioned values. Besides, contemporary concepts about risk stratification of malignant arrhythmias and sudden cardiac death in patients with ischemic heart disease and about the value of each prognostic marker for patient selection for the purpose of cardioverter-defibrillator implantation.

References

1. Голухова Е. З. Внезапная сердечная смерть. Ме- няют ли результаты рандомизированных иссле- дований наши представления о возможных предикторах и путях профилактики? // Креат. кардиол. 2008. №1. С. 7–24.

2. Какучая Т. Т. Тканевый допплер, деформация и скорость деформации миокарда в оценке функ- ции миокарда – концептуальные технические основы и применение в клинике // Креат. кар- диол. 2008. №1. С. 73–93.

3. Avoort C. J., Filion K. B., Dendukuri N., Brophy J. M. Microvolt T-wave alternans as a predictor of mortality and severe arrytmias in patients with left ventricular dysfunction: a systematic review and metaanalysis // BMC Cardiovasc. Disord. 2009. Vol. 28, № 9. P. 5.

4. Barbier C. E., Bjerner T., Johansson L. et al. Myocardial scars more frequent than expected. Magnetic resonance imaging detects potential risk group // J. Am. Coll. Cardiol. 2006. Vol. 48. P. 765–771.

5. Bauer A., Barthel P., Schneider R. Improved Stratification of Autonomic Regulation for risk prediction in post-infarction patients with preserved left ventricular function (ISAR-Risk) // Eur. Heart J. 2009. Vol. 30. P. 576–583.

6. Bauer A., Guzik P., Barthel P. et al. Reduced prognostic power of ventricular late potentials in postinfarction patients of the reperfusion era // Eur. Heart J. 2005. Vol. 26. P. 755–761.

7. Bigger J. T. Jr, Whang W., Rottman J. N. et al. Mechanisms of death in the CABG Patch trial: a randomized trial of implantable cardiac defibrillator prophylaxis in patients at high risk of death after coronary artery bypass graft surgery // Circulation. 1999. Vol. 99. P. 1416–1421.

8. Bloomfield D. M., Hohnloser S. H. Interpretation and classification of microvolt T-wave alternans tests // J. Cardiovasc. Electrophysiol. 2002. Vol. 13. P. 502–512.

9. Bloomfield D. M., Steinman R. C., Namerow P. B. et al. Microvolt T-wave alternans distinguishes between patients likely and patients not likely to benefit from implanted cardiac defibrillator therapy: a solution to the Multicenter Automatic Defibrillator Implantation Trial (MADIT) II conundrum // Circulation. 2004. Vol. 110. P. 1885–1889.

10. Chow T., Kereiakes D. J., Bartone C. et al. Prognostic utility of microvolt T-wave alternans in risk stratification of patients with ischemic cardiomyopathy // J. Am. Coll. Cardiol. 2006. Vol. 47. P. 1820–1827.

11. Chugh S. S., Reinier K. Determinants of prolonged Q–T interval and their contribution to sudden death risk in coronary artery disease: the Oregon sudden unexpected death study // Circulation. 2009. Vol. 119. P. 663–670.

12. Costantini O., Hohnloser S. H., Kirk M. M. et al. The ABCD (Alternans Before Cardioverter Defibrillator) Trial: strategies using T-wave alternans to improve efficiency of sudden cardiac death prevention // J. Am. Coll. Cardiol. 2009. Vol. 53. P. 471–479.

13. Daniels L. B., Maisel A. S. Natriuretic peptides // J. Am. Coll. Cardiol. 2007. Vol. 50. P. 2357–2368.

14. Epstein A. E., DiMarco J. P. American College of Cardiology/ American Heart Association/Heart Rhythm Society 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: A Report of the American College of Cardiology/ American Association Task Force on Practice Guidelines (Writing Committee to Heart Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Developed in Collaboration Cardiac Pacemakers and Antiarrhythmia Devices) With the American Association for Thoracic Surgery and Society of Thoracic Surgeons // J. Am. Coll. Cardiol. 2008. Vol. 51. P. e1–e62.

15. Exner D. V., Kavanagh K. M., Slawnych M. P. Noninvasive risk assessment early after a myocardial infarction: The REFINE Study // J. Am. Coll. Cardiol. 2007. Vol. 50. P. 2275–2284.

16. Fishman G. I., Chugh S. S., DiMarco J. P. et al. Sudden cardiac death prediction and prevention report from a National Heart, Lung, and Blood Institute and Heart Rhythm Society Workshop // Circulation. 2010. Vol. 122, № 22. P. 2335–2348.

17. Gehi A. K., Stein R. H., Metz L. D., Gomes J. A. Microvolt T-wave alternans for the risk stratification of ventricular tachyarrhythmic events: a meta-analysis // J. Am. Coll. Cardiol. 2005. Vol. 46, № 1. P. 75–82.

18. Gold M. R., Bloomfield D. M., Anderson K. P. et al. A comparison of T-wave alternans, signal averaged electrocardiography and programmed ventricular stimulation for arrhythmia risk stratification // J. Am. Coll. Cardiol. 2000. Vol. 36, № 7. P. 2247–2253.

19. Gold M. R., Ip J. H. Role of microvolt T-wave alternans in assessment of arrhythmia vulnerability among patients with heart failure and systolic dysfunction: primary results from Sudden Cardiac Death Heart Failure Trial Substudy // Circulation. 2008. Vol. 118. P. 2022–2028.

20. Goldberger J. J., Cain M. E., Hohnloser S. H. et al. American Heart Association/American College of Cardiology Foundation / Heart Rhythm Society Scientific Statement on Noninvasive Risk Stratification Techniques for Identifying Patients at Risk for Sudden Cardiac Death // J. Am. Coll. Cardiol. 2008. Vol. 52. P. 1179–1199.

21. Gomes J. A., Cain M. E., Buxton A. E. et al. Prediction of long-term outcomes by signal-averaged electrocardiography in patients with unsustained ventricular tachycardia, coronary artery disease, and left ventricular dysfunction // Circulation. 2001. Vol. 104. P. 436–441.

22. Haugaa K. H., Smedsrud M. K. Mechanical dispersion assessed by myocardial strain in patients after myocardial infarction for risk prediction of ventricular arrhythmia // J. Am. Coll. Cardiol. Img. 2010. Vol. 3. P. 247–256.

23. Hohnloser S. H., Klingenheben T. et al. T-wave alternans during exercise and atrial pacing in humans // J. Cardiovasc. Electrophysiol. 1997. Vol. 8. P. 987–993.

24. Huikuri H. V., Exner D. V. CARISMA and REFINE Investigators. Attenuated recovery of heart rate turbulence early after myocardial infarction identifies patients at high risk for fatal or nearfatal arrhythmic events // Heart Rhythm. 2010. Vol. 7, № 2. P. 229–235.

25. Iacoviello M., Forleo C., Guida P. et al. Ventricular repolarization dynamicity provides independent prognostic information toward major arrhythmic events in patients with idiopathic dilated cardiomyopathy// J. Am. Coll. Cardiol. 2007. Vol. 50. P. 225–231.

26. Ikeda T., Yoshino H., Sugi K. et al. Predictive value of microvolt T-wave alternans for sudden cardiac death in patients with preserved cardiac function after acute myocardial infarction: results of a collaborative cohort study // J. Am. Coll. Cardiol. 2006. Vol. 48. P. 2268–2274.

27. Kanoupakis E. M., Manios E. G., Kallergis E. M. et al. Serum markers of collagen turnover predict future shocks in implantable cardioverter-defibrillator recipients with dilated cardiomyopathy on optimal treatment// J. Am. Coll. Cardiol. 2010. Vol. 55. P. 2753–2759.

28. Kwong R. Y., Chan A. K., Brown K. A. et al. Impact of unrecognized myocardial scar detected by cardiac magnetic resonance imaging on event-free survival in patients presenting with signs or symptoms of coronary artery disease // Circulation. 2006. Vol. 113. P. 2733–2743.

29. La Rovere M. T., Bigger J. T. Jr, Marcus F. I. et al. Baroreflex sensitivity and heart-rate variability in prediction of total cardiac mortality after myocardial infarction. ATRAMI (Autonomic Tone and Reflexes After Myocardial Infarction) Investigators // Lancet. 1998. Vol. 351, № 9101. P. 478–484.

30. La Rovere M. T., Pinna G. D. Baroreflex sensitivity and heart rate variability in the identification of patient of risk for life-threatining arrhythmias: implications for clinical trials// Circulation. 2001. Vol. 103. P. 2072–2077.

31. Mahnken A. H., Koos R. Assessment of myocardial viability reperfused acute myocardial infarction using 16-slice computed tomography in comparison to magnetic resonance imaging // J. Am. Coll. Cardiol. 2005. Vol. 45. P. 2042–2047.

32. Marcus G. M. Can serologic markers of fibrosis reveal an arrhythmogenic ventricular substrate in nonischemic dilated cardiomyopathy? // J. Am. Coll. Cardiol. 2010. Vol. 55, № 24 (Editorial comment.).

33. Myerburg R. J., Interian A., Simmons J., Castellanos A. Sudden cardiac death. Cardiac electrophysiology: from cell to bedside / Ed. D. P. Zipes. 4th ed. Philadelphia: WB Saunders, 2004. P. 720–731.

34. Nieminen T., Lehtima T., Viik J. et al. T-wave alternans predicts mortality in a population undergoing a clinically indicated exercise test // Eur. Heart J. 2007. Vol. 28. P. 2332–2337.

35. Patton K. K., Sotoodehnia N., DeFilippi C. et al. N-terminal pro-B-type natriuretic peptide is associated with sudden cardiac death risk: the Cardiovascular Health Study // Heart Rhythm. 2011. Vol. 8. P. 228–233.

36. Pfeffer M. A., McMurray J. J. V., Velazquez E. J. et al. Valsartan, Captopril, or both in myocardial infarction complicated by heart failure, left ventricular dysfunction, or both // N. Engl. J. Med. 2003. Vol. 349. P. 1893–1906.

37. Piccini J. P., Zhang M., Pieper K. et al. Predictors of sudden cardiac death change with time after myocardial infarction: results from the VALIANT trial // Eur. Heart J. 2010. Vol. 31. P. 211–221.

38. Roes S. D., Borleffs C. J. W. et al. Infarct tissue heterogeneity with contrast-enhanced MRI predicts spontaneous ventricular arrhythmia in patients with ischemic cardiomyopathy and implatable cardioverter- defibrillator // Circ. Cardiovasc. Imaging. 2009. Vol. 2. P. 183–190.

39. Rosenbaum D. S., Jackson L. E., Smith J. M. et al. Electrical alternans and vulnerability to ventricular arrhythmias // N. Engl. J. Med. 1994. Vol. 330. P. 235–241.

40. Rubart M., Zipes D. P. Mechanisms of sudden cardiac death// J. Clin. Invest. 2005. Vol. 115. P. 2305–2315.

41. Scott P. A., Barry J., Roberts P. R., Morgan J. M. Brain natriuretic peptide for the prediction of sudden cardiac death and ventricular arrhythmias: A meta-analysis // Eur. J. Heart Failure. 2009. Vol. 11. P. 958–966.

42. Shmidt A., Azevedo C. F. et al. Infarct tissue heterogeneity by magnetic resonance imaging identifies enhanced cardiac arrhythmia susceptibility in patients with left ventricular dysfunction // Circulation. 2007. Vol. 115. P. 2006–2014.

43. Tracy C. M., Epstein A. E. et al. 2012 ACCF/AHA/HRS Focused Update of the 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines // Circulation. 2012. Vol. 126. P. 1–17.

44. Walker M. L., Rosenbaum D. S. Repolarisation alternans: Implications for the mechanisms and prevention of sudden cardiac death // Cardiovasc. Res. 2003. Vol. 57. P. 599–614.

45. Yan A. T., Shayne A. J. et al. Characterization of the peri-infarct zone by contrast-enhanced cardiac magnetic resonance imaging is a powerful predictor of post-myocardial infarction mortality // Circulation. 2006. Vol. 114. P. 32–39.

46. Zethelius B., Berglund L., Sundstrцm J. et al. Use of multiple biomarkers to improve the prediction of death from cardiovascular causes // N. Engl. J. Med. 2008. Vol. 358. P. 2107–2116.

47. Zipes D. P., Rubart M. Neural modulation of cardiac arrhythmias and sudden death // Heart Rhythm. 2006. Vol. 3. P. 108–113.

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery