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Tải xuống
Trong một loạt các bệnh nhân với nhồi máu cơ tim phía trước, tất cả các người trong số họ đã trải qua chính vành nong mạch vành qua da (PTCA), sự hiện diện của hạn chế tâm trương làm đầy | Risk stratification for SCD 51 In another series of patients with an anterior myocardial infarction all of whom underwent primary percutaneous transluminal coronary angioplasty PTCA the presence of restrictive diastolic filling as defined by deceleration time on echocardiography of less than 130 ms was asoociated with a 2-year mortality over a mean of 12 months of 21 versus only 1 in patients without restrictive features 15 . Data such as these point to the presence of smaller patient subgroups 13 of the total in this series who may well benefit from further risk stratification. On the other hand these data also suggest that the remaining 73 of patients with an excellent prognosis might not require any additional risk stratification given a mortality rate of only 1 at 2 years. What is important in this study is that the predictive power of diastolic dysfunction was independent of ejection fraction. Ambulatory ECG monitoring Ambulatory Holter monitoring is a comprehensive tool for identifying and quantifying factors that might contribute to the mechanism of SCD Figure 4.2 . Historically detecting and quantifying Holter-recorded ventricular arrhythmias was the first ECG-based approach to determine the risk of patients and to implement antiarrhythmic therapy 1 . There is clear association between increased frequency and complexity of ventricular arrhythmias with cardiac and SCD. However diminishing these arrhythmias with pharmacological agents was not leading to improved survival and in case of several drugs such therapy was associated with worse outcome 1 . Primary prevention of sudden death with ICD therapy was introduced by Multicenter Automatic Defibrillator Implantation Trial MADIT and MUSTT in patients Autonomic nervous system Heart-rate variability Baroreflex sensitivity Cardiac death Myocardial substrate EF Atrial fibrillation QRS QTc 4 T-wave morphology Myocardial vulnerability Ischemia Ventricular arrhythmias QT T-Wave variability Figure 4.2 Factors .
