心脏猝死高危患者的识别与评估附75例ICD心脏猝死一级预.ppt

谢谢！ Thank you for your attention 天津医科大学心血管病临床学院 泰达国际心血管病医院 Clinical Cardiovascular College, Tian Jin Medical University Department of Cardiology, TEDA International Cardiovascular Hospital 齐向前 二0一一年七月 * * * * * 器质性心脏病是指心脏血管受致病因素的作用,导致组织结构的变化所引起的心血管疾病。临床上习惯称为器质性心血管病(structural cardiovascular disease)。大多数心脏病都是器质性心脏病。如先天性心脏病、高血压及高血压性心脏病、动脉粥样硬化及冠状动脉粥样硬化性心脏病、风湿性心脏病、肺原性心脏病,原发性或继发性心肌病等, organic heart disease; organic heart diseases; structural heart disease; 美国纽约心脏病学会（NYHA）1928年心功能分级：Ⅰ级：患者患有心脏病但活动量不受限制，平时一般活动不引起疲乏、心悸、呼吸困难或心绞痛。Ⅱ级：心脏病患者的体力活动受到轻度的限制，休息时无自觉症状，但平时一般活动下可出现疲乏、心悸、呼吸困难或心绞痛。Ⅲ级：心脏病患者体力活动明显限制，小于平时一般活动即引起上述的症状。Ⅳ级：心脏病患者不能从事任何体力活动。休息状态下也出现心衰的症状，体力活动后加重 汇萃分析12项随机对照研究(n=8516)和76项观察性研究(n=96951), 对于LV收缩功能不全的患者, 86%NYHA II-III级, ICD可降低总死亡危险达20%(RCT)和46%(观察性研究) MI48小时后因VF发生心脏骤停，再发危险很高。此类患者需进行评估积极改善心脏缺血，如果有明确和直接的证据提示VF发生前的瞬间有心肌缺血，而且既往无MI，首选冠状动脉血供重建。如果无法行相关治疗且伴显著的LV功能障碍，首选ICD * 225,000 to 300,000 of SCD patients in the U.S. have had a previous MI. * AMI： * A relatively high rate of mortality was noted for all six arrhythmia groups, with 2-year survival rates ranging from 76% in patients presenting with syncopal VT to 84% in patients with unexplained syncope and inducible VT. 2Anderson JL, Hallstrom AP, Epstein AE, et al. Design and Results of the Antiarrhythmics vs Implantable Defibrillators (AVID) Registry. Circ. 1999;99:1692-1699. * #5 is a new recommendation (new in 2002) that is related to #2 on the previous slide. When drug therapy or ablation are not options for the patient with sustained VT and a normal heart, an ICD is indicated. * Patients with LV dysfunction had higher rates of sudden cardiac death, than patients without LV dysfunction in the GISSI-2 Trial. Patients with more frequent PVBs had a higher rate of sudden cardiac death in patients with and without LV dysfunction. 8,676 post-myocardial infarction patients of the GISSI-2 study were analyzed for the presence of ventricular arrhythmias. Patients were followed for 6 month