信号平均心电图频谱时间标测预测急性心肌梗塞后心律失常事件的评价

ASSESSMENT ON THE PREDICTIVE VALUE OF SPECTROTEMPORAL MAPPING OF SIGNAL AVERAGED ELECTROCARDIOGRAPHY FOR ARRHYTHMIC EVENTS AFTER ACUTE MYOCARDIAL INFARCTION

本文前瞻性地分析了信号平均心电图(SAECG)频谱时间标测(Spectrotemporal Mapping,STM)改良方法的结果对79例急性心肌梗塞(AMI)患者梗塞后发生心律失常事件(AE)的预测价值。79例患者均行SAECG STM分析,生存者均随访1年或以上,平均随访25.3±8.7月,随访率94%。住院与随访期间共12例(15%)发生AE,其中8例为持续性室速/室颤(VTs/VF)(4例复苏失败),4例为猝死。79例中24例(30%)STM结果异常即心室晚电位(LP)阳性。LP阳性组患者发生AE危险性明显高于LP阴性组(33%对7%,P<0.01)。多因素Cox分析STM、LVEF、Holter及UCG室壁活动指数4项变量,显示STM为唯一能预测AMI后AE的指标。STM结果预测AMI后AE的敏感性、特异性、准确性及阳性与阴性预测值分别为67%、76%、75%、33%及93%;预测AMI后VTs/VF的上述指标分别为88%、76%、77%、29%及98%。

We studied prospectively to assess the predictive value of spectrotemporal mapping (STM) of signal averaged electrocardiography (SAECG) for arrhythmic event (AE)in 79 patients with acute myocardial infarction. During a mean follow-up period of 25.3 (12-42) months, 12 patients (15%) had AE, 8 of which had sustained ventricular tachycardia/ventricular fibrillation (VTs/VF), and the remaining 4 died suddenly. The presence of late potentials (LP) was defined as NF <33% on any individual X, Y, Z lead. In 24 of the 79 patients LP were observed. The occurrence rates of both AE and VTs/VT were higher in patients with LP versus without LP (33% versus 7%, p<0.01; 29% versus 2%, p<0.001, repectively). Comparing the results of the 4 noninvasive tests of STM, Hoher, radionuclide ventriculography and echoeardiography by Cox proportional hazard model, STM was the only independent and significant predictor for AE after AMI. The sensitivity, specificity, predictive accuracy, positive predictive value and negative predictive value of STM for AE was 67%, 76%, 75%, 33% and 93% respectively; that for VTs/VT was 88%, 76%, 77%, 29% and 98% respectively.