AMI伴RBBB合并T波电交替患者室性早搏Lown分级的相关性分析

Association study of Microvolt T Wave Alternans and ventricular premature Lown grades in acute myocardial infarction patients with right bundle branch block

目的 探讨微伏级T波电交替(Microvolt T Wave Alternans, MTWA)与急性心肌梗死(Acute Myocardial Infarction, AMI)合并右束支阻滞(Right Bundle Branch Block, RBBB)患者室性早搏Lown分级的相关性。方法 选择64例PCI术后的AMI合并RBBB患者进行回顾性研究。运用迪姆动态心电图分析软件时域法检测MTWA。采用单因素Logistic回归、多因素Logistic回归方法评估MTWA与室性早搏Lown分级之间的相关性。根据动态心电图室性早搏Lown分级情况,分为Ⅲ级以下组(A组,44例)及Ⅲ级及以上组(B组,20例)。并通过倾向性评分匹配(PSM)的方式平衡两组患者临床特征的差异,对比两组间MTWA的阳性率。结果 多因素Logistic回归分析结果显示,与MTWA阴性患者相比,MTWA阳性患者有较高的室性早搏Lown分级(OR=182.065,95%CI:12.327~2689.091,p=0)。通过倾向评分(Propensity Score Matching, PSM)方法共对完成匹配12对,匹配后A组和B组的MTWA阳性率(0%vs. 83.3%),差异有统计学意义(p=0.002)。结论 微伏级T波电交替可作为预测AMI合并RBBB患者发生室性心律失常风险的指标,为此类患者提供防治参考。

Objective To investigate the association between microvolt T wave alternans(MTWA) and ventricular premature Lown grades in patients with acute myocardial infarction(AMI) and right bundle branch block(RBBB). Methods We retrospectively analyzed the clinical data of 64 AMI patients with RBBB after PCI. The Time-domain method was used to detect MTWA. Univariate Logistic regression and multivariate Logistic regression were used to evaluate the correlation between MTWA and ventricular premature Lown grades. According to the Lown grades on ambulatory electrocardiogram, they were divided into group below grade Ⅲ(group A, n=44) and group above grade Ⅲ(group B, n=20). The difference of clinical characteristics between the two groups was balanced by propensity score matching(PSM), and the positive rate of MTWA between the two groups was compared. Results Multivariate Logistic regression analysis showed that compared with MTWA negative patients, MTWA positive patients had higher Lown grades(OR=182.065, 95%CI: 12.327~2689.091, p=0). A total of 12 pairs were matched through PSM. After matching, the positive rate of MTWA in group A and group B(0% vs. 83.3%) was statistically significant(p=0.002). Conclusions MTWA can be used as an index to predict the risk of ventricular arrhythmia in AMI patients with RBBB, and provide prevention and treatment reference for such patients.