心率漂移对急性心肌梗死恢复期死亡率的预测价值

Previsional value of heart-rate turbulence in mortality during recovery period with acute myocardial infarction

目的对急性心肌梗死(AMI)恢复期室性早搏后心率漂移进行分析,并与心率变异性(HRV)、左室射血分数(LVEF)同期进行比较,揭示心率漂移是一种强有力的AMI恢复期死亡率的独立预报因子。方法回顾性分析130例AMI恢复期患者,提取心率漂移指标:室性早搏后最初两个RR间期的均值(R1R3)与早搏前的最后两个RR间期的均值(R-1R-3)之差除以早搏前最后两个RR间期的均值所得,以百分率表示。HRV指标:24小时平均RR间期的标准差(SDNN)、LVEF(%)。结果死亡组心率漂移多数≥0与存活线存在明显差异(P<0.05),SDNN降低、LVFE降低(P<0.05)。在Logistic单因素分析中,LVEF及心率漂移有统计学意义(P<0.05),性别、年龄、SDNN则无统计学意义。在多因素分析中,心率漂移可作为独立的AMI恢复期死亡率预报因子(P<0.001),LVEF次之(P<0.01)。结论室性早搏后出现窦性心率先加速后减慢是缺血性心脏病低危病人的一种现象,而室早后上述现象迟钝或缺如,致心率漂移≥0,是AMI恢复期一种非常有力的独立预报死亡因子,其预报价值大于目前已知的其他因素。

Objective To analyze Heart-rate turbulence after ventricular premature beats (VPB) during recovery period with acute myocardial infarction (AMI) . Compared with heart-rate variability (HBV), left ventricular ejection fraction (LVEF) in same period.To unveil the clinical practical value of heart-rate turbulence. Method Retrospective analysis ambulatory electrocardiographic and echocardiographic monitorings of 130 AMI patients duing recovery period.Sign of heart-rate turbulence is defined as the diffierence between the mean of the first two sinus RR intervals after a VPB and the last two sinus RR intervals before the VPB divided by the mean of the last two sinus RR intervals before the VPB,as well as R1R3-R-1R-3/R-1R-3.HRV:Selected standard difference of average RR interval in 24 hours (SDNN).Results In dead group,heart-tate turbulence were≥0 in most cases,(P<0.05).SDNN and LVEF were reduced,(P<0.05). In analysis of Logistic single factor,heart-rate furbulence and LVEF have obvious statistical significance (P<0.05), In analysis of Logistic abundant factor,heart-rate turbulence is a independent information on the risk of subsequent mortality duing revovery period with AMI(p<0.001),LVEF(p<0.01).Conclusion In low-risk patients with ischaemic heart disease,sinus rhythm shows a characteristic pattern of early acceleration and subsequent decelqration after a VPB. The obtues or absence of this phenomenon after VPB,heart-rate turbulence≥0,indicates a significantly increased risk of subsequent mortality. It is avery potent post infarction risk stratifier that is independent of other known risk factors and is stronger than other presently available factors.