在运动性心脏猝死的男性中已知的心脏病多见
旧金山——据美国心律学会年度学术会议上公布的一项仍在进行中的大型前瞻性研究,在发生运动性心脏猝死(SCA)的中年男性病例中,51%原先存在已知的心脏病以及至少2项确定的心脏危险因素,31%在发生心脏猝死之前就存在心血管症状。
EloiMarijon医生在会后受访时表示,预防运动期间发生SCA的措施包括对运动者进行教育:如果存在已知的心脏病,进行运动的方式则应有所不同,并且应警惕预示性征兆。
在这项进行中的Oregon-SUDS(俄勒冈州突发性意外死亡研究)研究中,Marijon医生及其合作者在2012年一整年中从俄勒冈州波特兰市944名年龄介于35~65岁的男性中查找心脏猝死病例,其中包括对终生病史进行系统性和综合性评估,这是旨在探究美国社区内运动期间心脏猝死的第一项研究工作。不过,近期欧洲同行的经验突出表明这样一点,即在社区内,运动性SCA病例中从事运动的中年男性位居榜首。遗憾的是,目前除了仅有的为数不多的有关特定娱乐活动的数据外,就我们所知,尚无在美国任何社区对中年人群评价运动期间SCA发生情况的研究。
该研究结果表明,在944例SCA病例中,59例(6%)发生于运动期间,平均年龄为51岁,这意味着每年41例/100万人的发生率。运动性SCA被目击的概率显著高于其他非运动性SCA(分别为86% vs. 53%),旁观者实施心肺复苏(46% vs.26%)及室颤的发生率(84% vs. 57%)亦较高。另外,运动性SCA病例的存活出院率是非运动性SCA病例的近2倍(25% vs. 13%)。运动性SCA病例中略过半数(51%)原先就已经存在心脏病和至少2项心脏危险因素,而将近1/3(31%)在发生SCA事件前就存在心血管症状,所以可以有针对性的进行干预。
尽管研究者们考虑了所有病例终生的既往病史,但探讨SCA仍然别具挑战性,尤其是因为绝大多数受试者死于运动现场,而后续的由急诊人员搜集的信息往往局限于复苏过程,SCA患者具体的既往史(特别是那些无法进行复苏的患者)也因此常常缺如,甚至是少到无系统性可言。
Oregon-SUDS的主要研究者是雪松西奈山心脏研究所(Cedars-Sinai Heart Institute)基因组心脏病学部的Sumeet S. Chugh医生。本研究由美国心肺血液研究所资助。Marijon医生无相关的经济利益披露
SAN FRANCISCO – Among cases of sports-associated sudden cardiac death in middle-age men, 51% had known preexisting cardiac disease and at least two documented cardiac risk factors, and 31% had cardiovascular symptoms that preceded the sudden cardiac arrest event, results from large ongoing prospective study showed.
"The prevention of SCD during sports should include education of sport participants: The way of practicing sports should be different if you have a known heart disease," and warning symptoms should be heeded, one of the study authors, Dr. EloiMarijon said in an interview after the annual scientific sessions of the Heart Rhythm Society, where the study was presented.
In the ongoing Oregon-SUDS (Oregon Sudden Unexpected Death Study), Dr. Marijon and his associates identified sudden cardiac arrest (SCA) cases among 944 men aged 35-65 years in the metropolitan area of Portland, Oregon, during 2012-2012, including systematic and comprehensive assessment of their lifetime medical history. "This is the first work aiming to study sudden cardiac death during sports in the community in United States," said Dr. Marijon, a visiting faculty scientist at Cedars-Sinai Medical Center, Los Angeles. "There are some data in the European Union, but data from the United States were coming only from studies carried out among young competitive athletes," he said. These U.S. studies have allowed for significant improvements in the field, notably initiation and optimization of preventive strategies.
However, "recent European experience has emphasized that, in the community, the largest burden of sports-associated SCA results from events among male middle-age participants. However, except for limited data on specific recreational sport activities there are, to the best of our knowledge, no studies evaluating SCA during sports among middle-age subjects in any United States community."
The researchers found that among the 944 SCA cases, 59 (6%) occurred during sports at a mean age of 51 years, which translated into an incidence of 41/million per year. SCA cases associated with sports activity were significantly more likely to be a witnessed event than were those not related to sports (86% vs. 53, respectively), with higher rates of bystander cardiopulmonary resuscitation (46% vs. 26%) and ventricular fibrillation as the presenting rhythm (84% vs. 57%). In addition, survival to hospital discharge was nearly twice as high for sports-related SCA cases than for nonsports–related SCA cases (25% vs. 13%).
The researchers also found that slightly more than half of sports-related SCA cases (51%) had known preexisting cardiac disease and at least two documented cardiac risk factors, while nearly one-third (31%) had cardiovascular symptoms that preceded the SCA event, "opening room for intervention," Dr. Marijon said.
Even though the researchers considered lifetime past medical history in all cases, "investigation of SCA remains particularly challenging, especially since a great majority of subjects die in the field, and consequently the information collected by emergency medical services is often restricted to data regarding the resuscitation process," Dr. Marijon noted. "Details of the past medical history of SCA patients (especially those that cannot be resuscitated) are thus usually sparse and very rarely considered systematically."
The principal investigator of Oregon-SUDS is Dr. Sumeet S. Chugh of the department of genomic cardiology at the Cedars-Sinai Heart Institute.
The study was funded by the National Heart, Lung, and Blood Institute. Dr. Marijon had no relevant financial conflicts of interest to disclose.
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