血脂異常對心臟電器生理及機械功能之影響
Other Title
The Study of Dyslipidemia and the Cardiac Electromechanical
Dysfunction
Dysfunction
Date Issued
1999
Date
1999
Author(s)
吳造中
DOI
882314B002333
Abstract
Background Ventricular tachycardia/fibrillation (VT/VF) developing in the acute stage
of myocardial infarction is a primary factor of sudden cardiac death that still remains as
a major problem in contemporary cardiology. Several animal studies have shown that
dyslipidemia can alter the lipid composition of myocardial membrane and subsequently
increases the susceptibility of cardiac arrhythmia. To the best of our knowledge, there
have been no previous human studies providing the longitudinal evidence of a
relationship between plasma dyslipidemia and arrhythmia. The aim of this study is to
determinate whether dyslipidemia is a predisposing factor of the occurrence of VT/VF
during the acute stage of myocardial infarction.
Methods and Results A total of 58 patients experiencing VT/VF within 24 hours after
the onset of chest pain were matched to 58 patients without such clinical events. Sex
(104 males), age (58+10 years), and the use of thrombolytic therapy (n=82) were
required to matched in both groups initially. To diagnose a patient with dyslipidemia,
the lipid profiles including total cholesterol (TC), high-density lipoprotein cholesterol
(HDL-C), low-density lipoprotein cholesterol (LDL-C), and triglyceride (TG) were
measured during patients’ hospitalization period (day 1 and day 7) and the outpatient
follow up at the 3rd month after the index event. Other coronary risk factors, as well as
clinical, hemodynamic, and angiographic characteristics were also included in our
assessment. The mean serum levels of TC, HDL-C, LDL-C, and TG measured during
hospitalization were all lower than those measured 3 months later (-9%, P=0.0003; -6%,
P=0.08; -10%, P=0.004; and –9%, P=0.16, respectively). A unique and intriguing
pattern was observed in the patients with incidence of VT/VF. During the acute stage,
they had a higher level of LDL-C (137.6+35.6 vs. 122.5+31.3 mg/dl, P=0.02), a lower
mean blood pressure (89.0 ±18.7 vs. 99.8 ±17.4 mmHg, P=0.002), and a higher
percentage with Killip class III or IV (16 vs. 5%, P=0.127) on the initial arrival. At the
3-month follow up, these patients with experience of VT/VF had a higher level of TC
(224.6+42.2 vs. 198.2+33.2 mg/dl, P<0.001), LDL-C (159.4+38.1 vs. 128.3+30.0 mg/dl,
P<0.0001), and TG (179.8+102.3 vs. 136.6+68.4 mg/dl, P=0.009). In multivariate
analysis, the LDL cholesterol ( P=0.0009) at the 3-month follow up, the mean blood
pressure on arrival ( P=0.0025), and the difference in level of triglyceride between the
first week and the third month ( P=0.0466) were all accounted the independent
predictors for the occurrence of VT/VF in the acute stage of myocardial infarction.
Conclusions This study suggested that dyslipidemia imposed a higher risk of
developing VT/VF in the acute phase of myocardial infarction. It might partly explain
the reason why the current treatment with lipid-lowering drugs could reduce the risk of major coronary events, including sudden cardiac death, in recently published large-scale
study trials.
Subjects
Dyslipidemia
Ventricular tachycardia/fibrillation
Myocardial infarction
Publisher
臺北市：國立臺灣大學醫學院內科
Type
report
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