抗不整脈薬の効果予測のための遺伝子変異と高分解能心電図指標による探索的研究

抄録

The number of cases with heart failure (HF) is increasing with the progress of aging in Japan. Lethal arrhythmias such as sustained ventricular tachycardia or ventricular fibrillation are the primary causes of sudden cardiac death (SCD). Therefore, the use of an implantable cardioverter-defibrillator as a treatment is recommended for reducing the incidence of SCD among HF patients with a high risk of SCD. However, an effective approach to predict SCD has not been fully elucidated for treating dilated cardiomyopathy (DCM）―the main cause of heart disease in heart transplant recipients in Japan. Here, we determine the genetic variants and electrocardiographic parameters using 187-channel repolarization interval-difference mapping electrocardiography (187-ch RIDM-ECG) in patients with DCM. The group of patients with any genetic variants did not exhibit a significant difference in the rates of patients with antiarrhythmic drug (amiodarone) and prognosis than the group of patients without any genetic variants. However, in cases with specific genetic variants such as lamin A/C（LMNA）and titin（TTN）mutations, the RT dispersion and Tp-e dispersion were associated with the effect of drug treatment and prognosis. Additionally, in cases without the genetic variant, the RT dispersion and Tp-e dispersion were significantly associated with prognosis. For the appropriate drug treatment for HF, in addition to genetic testing, it is necessary to establish a prediction method using effective diagnostic techniques such as 187-ch RIDM-ECG.