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完整後設資料紀錄
DC 欄位 | 值 | 語言 |
---|---|---|
dc.contributor.advisor | 簡國龍 | zh_TW |
dc.contributor.advisor | Kuo-Liong Chien | en |
dc.contributor.author | 賀立婷 | zh_TW |
dc.contributor.author | Li-Ting Ho | en |
dc.date.accessioned | 2024-02-26T16:14:48Z | - |
dc.date.available | 2024-02-27 | - |
dc.date.copyright | 2024-02-26 | - |
dc.date.issued | 2024 | - |
dc.date.submitted | 2024-01-09 | - |
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Non-invasive stereotactic arrhythmia radiotherapy for ventricular tachycardia: results of the prospective STARNL-1 trial. Eur Eur Pacing Arrhythm Card Electrophysiol J Work Groups Card Pacing Arrhythm Card Cell Electrophysiol Eur Soc Cardiol 2023;25(3):1015–24. 75. Wight J, Bigham T, Schwartz A, et al. Long Term Follow-Up of Stereotactic Body Radiation Therapy for Refractory Ventricular Tachycardia in Advanced Heart Failure Patients. Front Cardiovasc Med 2022;9:849113. 76. Robinson CG, Samson PP, Moore KMS, et al. Longer term results from a phase I/II study of EP-guided Noninvasive Cardiac Radioablation for Treatment of Ventricular Tachycardia (ENCORE-VT). Int J Radiat Oncol Biol Phys 2019;(105):682. | - |
dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/91877 | - |
dc.description.abstract | 背景
心因性猝死是由心血管事件引起的意外死亡。結構性心臟疾病,包括心臟衰竭,為大部分心因性猝死之病患。心因性猝死的預後通常不佳。本研究的目的是研究有心因性猝死風險患者的風險分析和預後預測。 方法 這項研究有三個主要題目。第一個題目是利用前瞻的急性後照顧病患,回朔性分析早期低射出分率心臟衰竭患者的左心室射出分率恢復的預測因子,並與持續低射出分率心臟衰竭患者比較預後。第二個題目是使用定量腦波來預測心因性猝死後缺血性腦病患者的神經學預後。最後,第三個目標是評估因心室頻脈之心因性猝死病患,利用立體定位放射治療後的預後。 結果 關於第一個研究,處方β受體阻斷劑為射出分率進步的唯一獨立預測因子 (OR 2.11, 95% CI 1.10-4.08, P=0.03)。缺血性心肌病的診斷和QRS持續時間≥110ms是負面預測因子 (分別OR 0.49, 95% CI 0.27-0.88, P=0.02, 及OR 0.21, 95% CI 0.21-0.77, P=0.005)。進步射出分率心臟衰竭患者有較好的預後,死亡率較低 (HR 0.2, 95% CI 0.08-0.5, log-rank P<0.001)。在第二個研究中,結合腦波功率和腦波GFS,α波在預測神經學預後良好,有最高的預測價值 (AUC 0.861)。在第三個研究中,立體定位放射治療後,心室頻脈顯著減少 (術後六個月內減少86%)。兩年的存活率為80%。 結論 心因性猝死之預後依然不佳,然而藉由找到心衰竭恢復之預測因子,使用適當的腦波診斷工具,以及有效的心室頻脈治療,醫師能更佳的作心因性猝死之風險分類以及預後預測。 | zh_TW |
dc.description.abstract | Background
Sudden cardiac death (SCD) is an unexpected event resulting from a cardiovascular incident. Structural heart diseases, including heart failure, account for the majority of SCD cases. Unfortunately, the prognosis for SCD is generally poor. The aim of this study is to investigate risk assessment and outcome prediction for individuals at risk of sudden cardiac death. Methods This study included three topics. The first topic included prospective post-acute care cohort and retrospectively analyzed the predictors of left ventricular ejection fraction (LVEF) recovery in patients with early-stage heart failure and reduced ejection fraction and compared outcomes of heart failure with improved ejection fraction (HFimpEF) and persistent heart failure with reduced ejection fraction (HFrEF). The second topic involved utilizing quantitative electroencephalogram (EEG) to predict favorable or unfavorable outcomes in patients with hypoxic ischemic encephalopathy following SCD. Lastly, the third topic was to evaluate the outcomes of SCD survivors due to ventricular tachycardia (VT) after undergoing stereotactic body radiation therapy (SBRT). Results For the first topic, the prescription of beta-blockers was the only independent predictor of LVEF recovery (OR 2.11, 95% CI 1.10-4.08, P=0.03). A diagnosis of ischemic cardiomyopathy and a QRS duration of ≥110ms were found to be inverse predictors (OR 0.49, 95% CI 0.27-0.88, P=0.02, and OR 0.21, 95% CI 0.21-0.77, P=0.005, respectively). HFimpEF exhibited significantly better prognoses, with lower mortality rates (HR 0.2, 95% CI 0.08-0.5, log-rank P<0.001). In the second topic, the combination of EEG power and EEG global field synchronization (GFS) revealed that the alpha band had the highest predictive value (AUC 0.861) for determining a favorable outcome. In the third topic, the VT burden significantly decreased after SBRT treatment (decreased by 86% in post-treatment first 6 months). The two-year survival rates were 80%. Conclusion The prognosis for SCD remains poor. However, by identifying predictors of heart failure recovery, employing appropriate EEG diagnostic tools, and implementing effective VT treatments, clinicians could be more effectively categorize risk levels and forecast outcomes for patients who are at risk of sudden cardiac death. | en |
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dc.description.tableofcontents | 口試委員會審定書 i
致謝 ii Abstract iii 中文摘要 vi Abbreviation List viii 目錄 xi Chapter 1. Introduction 1 1.1. Overview of Sudden Cardiac Death 1 1.2. Study Topics 4 1.3. Part 1: Sudden Cardiac Death Risk Assessment in Patients with Heart Failure 5 1.3.1. Heart Failure with Reduced Ejection Fraction 5 1.3.2. Heart Failure and Sudden Cardiac Death 7 1.3.3. Heart Failure with Improved Ejection Fraction 8 1.3.4. Post-acute Care Program for Heart Failure with Reduced Ejection Fraction 9 1.3.5. Study Gaps and Study Aims 9 1.4. Part 2: Outcome Prediction in Sudden Cardiac Death Survivors 11 1.4.1. Hypoxic Ischemic Encephalopathy 11 1.4.2. Outcome Prediction Tools 11 1.4.3. Electroencephalogram 13 1.4.4. Global Field Synchronization 14 1.4.5. Study Gaps and Study Aims 15 1.5. Part 3: Outcome Evaluation in Sudden Cardiac Death Survivors after Undergoing Stereotactic Body Radiation Therapy 17 1.5.1. Ventricular Tachycardia 17 1.5.2. Catheter Ablation for Recurrent Ventricular Tachycardia 18 1.5.3. Stereotactic Body Radiation Therapy 19 1.5.4. Study Gaps and Study Aims 20 Chapter 2. Methods 22 2.1. Part 1: Sudden Cardiac Death Risk Assessment in Patients with Heart Failure 22 2.1.1. Subjects and Study Protocol (Figure 2-1) 22 2.1.2. Echocardiography Follow-up 24 2.1.3. Outcome Evaluation 25 2.1.4. Statistical Analysis 26 2.2. Part 2: Outcome Prediction in Sudden Cardiac Death Survivors 28 2.2.1. Subjects and Study Protocol (Figure 2-2) 28 2.2.2. Mathematical Model of Global Field Synchronization 29 (This part of the methodology was reviewed by Bess Ma. Fabinal Serafico M.Sc. from the Department of Biomedical Sciences and Engineering, National Central University.) 29 2.2.3. Electroencephalogram Analysis 30 2.2.4. Statistical Analysis 32 2.3. Part 3: Outcome Evaluation in Sudden Cardiac Death Survivors after Undergoing Stereotactic Body Radiation Therapy 35 2.3.1. Study Population and Study Protocol (Figure 2-3) 35 2.3.2. Scar Substrates Identification 37 2.3.3. Cardiac Radioablation 38 2.3.4. Outcome and Adverse Events Assessment 42 2.3.5. Statistical Analysis 45 Chapter 3. Results 46 3.1. Part 1: Sudden Cardiac Death Risk Assessment in Patients with Heart Failure 46 3.1.1. Baseline Characteristics of the Study Population 46 3.1.2. Predictors of HFimpEF 47 3.1.3. Clinical Outcomes 48 3.2. Part 2: Outcome Prediction in Sudden Cardiac Death Survivors 50 3.2.1. Baseline Characteristics of the Study Population 50 3.2.2. EEG Results 51 3.3. Part 3: Outcome Evaluation in Sudden Cardiac Death Survivors after Undergoing Stereotactic Body Radiation Therapy 55 3.3.1. Patient Population 55 3.3.2. Radiation Procedure 56 3.3.3. Efficacy 57 3.3.4. Adverse Events 58 3.3.5. Repeated Catheter Ablation 59 3.3.6. Cardiac Post SBRT Effects 60 Chapter 4. Discussion 62 4.1. Part 1: Sudden Cardiac Death Risk Assessment in Patients with Heart Failure 62 4.1.1. HFrEF VS. HFimpEF 62 4.1.2. Predictors of HFimpEF 64 4.1.3. Clinical Implications 66 4.1.4. Study Limitations 66 4.1.5. Conclusion 67 4.2. Part 2: Outcome Prediction in Sudden Cardiac Death Survivors 68 4.2.1. Outcome Prediction Tools 68 4.2.2. Electroencephalogram 70 4.2.3. Clinical Implications 74 4.2.4. Study Limitations 75 4.2.5. Conclusion 75 4.3. Part 3: Outcome Evaluation in Sudden Cardiac Death Survivors after Undergoing Stereotactic Body Radiation Therapy 76 4.3.1. Management of Recurrent VT 76 4.3.2. Comparison with Previous SBRT Studies 76 4.3.3. Clinical Implications 78 4.3.4. Study Limitations 78 4.3.5. Conclusion 79 4.4. Overall Conclusion 80 Figure 1-1. Etiology of sudden cardiac death 81 Figure 1-2. Study scheme 82 Figure 1-3. Treatment of heart failure with reduced ejection fraction 83 Figure 1-4. Post-acute care program in patients with heart failure 84 Figure 1-5. Common EEG patterns after cardiac arrest with definitions according to the American Clinical Neurophysiology Society (ACNS) EEG terminology 85 Figure 1-6. Examples of good outcome and poor outcome with EEG frequency plot and GFS plane 86 Figure 2-1. Study protocol of part 1 87 Figure 2-2. Study protocol of part 2 88 Figure 2-3. Study protocol of part 3 89 Figure 2-4. Noninvasive cardiac radioablation beam arrangement and isodose distributions 90 Figure 3-1. Flow chart of patient enrollment 91 Figure 3-2. Optimal cutoff point was obtained by automatic bootstrap to maximize the Youden index 92 Figure 3-3. Clinical outcomes according to HFimpEF and persistent HFrEF 93 Figure 3-4. Patient demographics and clinical parameters 95 Figure 3-5. Receiver operating characteristic curve of mean EEG power for each channel in different frequency bands (good outcome vs. poor outcome) 96 Figure 3-6. Receiver operating characteristic curve of global field synchronization for each channel in different frequency bands (good outcome vs. poor outcome) 97 Figure 3-7. Receiver operating characteristic curve of global field synchronization+mean EEG power for each channel in different frequency bands (good outcome vs. poor outcome) 98 Figure 3-8. Ventricular arrhythmia before and after SBRT treatment 99 Figure 3-9. VT recurrence of patients receiving SBRT 100 Figure 3-10. Overall survival of patients receiving SBRT 101 Figure 3-11. Example of repeated ablation in patient post SBRT 102 Figure 3-12. Histologic assessment of recipient’s heart after SBRT 103 Table 1-1. Glasgow coma scale (GCS) 105 Table 1-2. The APACHE II (Acute Physiology and Chronic Health Evaluation II) model 106 Table 1-3. Cerebral Performance Categories (CPC) Scale 109 Table 1-4. Modified Rankin Scale (mRS) 110 Table 1-5. Electroencephalogram frequency 111 Table 3-1. Clinical characteristics of patients with HFimpEF and persistent HFrEF 112 Table 3-2. Independent Predictors of HfimpEF 114 Table 3-3. Patient demographics and clinical parameters 115 Table 3-4. Values of average power of the 4 bands in the two outcome groups. G1 (good outcome) and G2 (poor outcome) 116 Table 3-5. GFS values of two outcome groups 117 Table 3-6. Sensitivity, specificity, PPV, NPV of each parameter to predict good outcome 118 Table 3-7. Patients’ clinical characteristics 119 Table 3-8. Patients’ treatment details and follow up 121 Chapter 5. References 123 Chapter 6. Supplements 131 | - |
dc.language.iso | en | - |
dc.title | 猝死風險病患之風險評估及預後預測 | zh_TW |
dc.title | Risk Assessment and Outcome Prediction in Patients with Sudden Cardiac Death Risk | en |
dc.type | Thesis | - |
dc.date.schoolyear | 112-1 | - |
dc.description.degree | 博士 | - |
dc.contributor.oralexamcommittee | 林亮宇;杜裕康;吳彥雯;方啟泰;羅孟宗 | zh_TW |
dc.contributor.oralexamcommittee | Lian-Yu Lin;Yu-Kang Tu;Yen-Wen Wu;Chi-Tai Fang;Men-Tzung Lo | en |
dc.subject.keyword | 低射出分率心臟衰竭,心室頻脈,心因性猝死,左心室射出分率,缺氧缺血性腦病變,腦波,神經學預後,全局場同步,立體定位放射治療, | zh_TW |
dc.subject.keyword | Heart failure with reduced rejection fraction,ventricular tachycardia,sudden cardiac death,left ventricular ejection fraction,hypoxic ischemic encephalopathy,electroencephalogram,neurological outcome,global field synchronization,stereotactic body radiation therapy, | en |
dc.relation.page | 131 | - |
dc.identifier.doi | 10.6342/NTU202400062 | - |
dc.rights.note | 同意授權(限校園內公開) | - |
dc.date.accepted | 2024-01-10 | - |
dc.contributor.author-college | 公共衛生學院 | - |
dc.contributor.author-dept | 流行病學與預防醫學研究所 | - |
顯示於系所單位: | 流行病學與預防醫學研究所 |
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