Clinical Analysis Of Risk Factors For DCM Patients With Ventricular Arrythmias

BackgroundDilated cardiomyopathy(DCM)is the most common kind of cardiomyopathy in clinic,which is characterized by unilateral or bilateral ventricular enlargement and decreased systolic function.Epidemiological studies show that the incidence of DCM in China is 9/100000.DCM is a kind of heterogeneous diseases,there are many pathogenesis.While the etiology of about 50%DCM can not be confirmed,which is classified as primary dilated cardiomyopathy.The cardiac enlargement,congestive heart failure,arrhythmia,embolism and sudden cardiac death(SCD)are included in the clinical manifestations of DCM.The prognosis of DCM is poor,the patients usually died of end-stage heart failure and SCD.The patients with DCM are often companied with comlex ventricular arrhythmias(VA),while malignant ventricular arrhythmias(MVA)are often the main causes of SCD.Therefore,we should pay more attention to the DCM patients with MVA.To provide early warning for DCM patients,the clinical data of the patients with DCM were collected by us,and the risk factors of DCM patients with VA were retrospectively analyzed in this study.ObjectivesTo explore the risk factors for various ventricular arrhythmias in patients with DCM.MethodsA total of 189 patients with dilated cardiomyopathy were collected from June 2015 to December 2019,and 40 healthy adults were also collected as control group.The detailed data of hospitalization records were collected,including medical history,general clinical data,NYHA cardiac function classification,laboratory indexes,12-lead synchronous body surface electrocardiogram,24-hour dynamic electrocardiogram,echocardiography,cardiac MRI,medication and other information.The patients were divided into groups according to the type of VA,and the differences of clinical indexes among the groups were compared.Results1.General data:according to the inclusion and exclusion criteria determined in this study,a total of 189 patients with DCM were included,including 126 males(66.7%)and 63 females(33.3%),aged 53.02±12.38 years.2.The levels of the resting heart rate,blood leukocyte count,red blood cell count,hemoglobin,hematocrit,transaminase,bilirubin,creatinine,urea nitrogen,cystatin C,uric acid,QRS interphase,QT interphase and QTc interphase in the observation group were higher than those in the control group,while the levels of arterial systolic blood pressure,high density lipoprotein and LVEF in the observation group were lower than those in the control group.The lowest heart rate from Holter in the observation group was higher than that in the control group,and no significant difference in the average heart rate was observed between the two groups.The time domain indexes of SDNN,SDANN index and SDNN index in the observation group were lower than those in the control group,but no difference in rMSSD and PNN50 were also detected between the two groups.3.The increased age,course of disease,cardiac function grade,left ventricular end-diastolic diameter,left atrial diameter,NT-proBNP in serum and the incidence of abnormal Q wave in ECG in DCM patients with frequent ventricular premature beats were higher than those of DCM patients without frequent ventricular premature beats.Increased age,LVEDD enlargement and abnormal Q wave of ECG were independently related to the the incidence of ventricular premature beats in DCM patients.Ventricular premature load was positively correlated with the increased age(rs=0.187,P<0.05),course of disease(rs=0.241,P<0.002),and LVEDD(rs=0.257,P<0.002).DCM with multiple ventricular premature beats is associated with the increased course of disease(HR=1.213,P<0.05),increased LVEDD(HR=1.092,P=0.003)and the increased age(HR=1.040,P=0.02).DCM with paired ventricular premature beats was associated with increased course of disease(HR=1.112,P<0.05),increased LVEDD(HR=1.090,P<0.001),and abnormal Q wave of ECG(HR=2.361,P=0.04).4.The average age,course of disease,cardiac function grade,left ventricular end diastolic diameter,NT-proBNP in serum and incidence of pathological Q wave in DCM with NSVT group were higher than those in NSVT negative group,while LVEF in DCM with NSVT group was lower than that in DCM without NSVT group.The increased age,increased ventricular premature load,the decreased LVEF,and abnormal Q wave in ECG were independently related to the incidence of NSVT in DCM.5.The course of disease,cardiac function grade,incidence of atrial fibrillation,and NT-proBNP in serum in DCM with MVA group were higher than those in MVA negative group.The LVEF and utilization rate of ?-receptor blockers in DCM with MVA group were lower than that in DCM without MVA group.Both the elevated NT-proBNP level and persistent atrial fibrillation are independent risk factors for MVA in patients with DCM.Furthermore,the AUC of NT-proBNP predicted MVA is 0.836,with the sensitivity is 91.3%,the specificity 63.9%,poor the positive predictive value 25.9%,and better the negative predictive value 98.1%.The adjusted rate is 67.2%,the positive likelihood ratio is 2.53,and the negative likelihood ratio is 0.14.Conclusions1.With the progression of DCM disease,the increased LVEDD is related to the frequent occurrence of ventricular premature beats,multi-source ventricular premature beats,paired ventricular premature beats and NSVT in DCM,but it is not related to MVA.2.DCM ventricular premature load is positively correlated with LVEDD,age and course of disease.3.The abnormal Q wave of ECG is related to the frequent ventricular premature beats and NSVT in DCM.4.The decrease of LVEF in patients with DCM is related to the occurrence of NSVT and MVA.5.Persistent atrial fibrillation can increase the incidence of MVA in DCM patients.The serumal NT-proBNP level is increased in DCM patients with MVA.The serumal NT-proBNP level has a good negative predictive value for MVA incidence in DCM patients.The lower the serum NT-proBNP level of DCM patients,the lower the risk of MVA.