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標題: | 猝死風險病患之風險評估及預後預測 Risk Assessment and Outcome Prediction in Patients with Sudden Cardiac Death Risk |
作者: | 賀立婷 Li-Ting Ho |
指導教授: | 簡國龍 Kuo-Liong Chien |
關鍵字: | 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, 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, |
出版年 : | 2024 |
學位: | 博士 |
摘要: | 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。 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. |
URI: | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/91877 |
DOI: | 10.6342/NTU202400062 |
全文授權: | 同意授權(限校園內公開) |
顯示於系所單位: | 流行病學與預防醫學研究所 |
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