急性岛叶梗死增加心电图异常和心脏猝死的发生

Acute insular infarct increases risk of electrocardiogram changes and sudden cardiac death

目的:探讨急性岛叶梗死部位及严重程度对梗死后心电图(ECG)改变及心血管负性事件(card iovascular events,CVE)的影响。方法:连续登记2007年10月至2009年6月从发病到入院小于48 h的首次诊断为大脑中动脉供血区脑梗死的患者99例,排除既往心脏病等病史。根据磁共振上岛叶累及范围,分大面积岛叶梗死、微小岛叶梗死和对照组,对比左右侧梗死的临床特征和梗死后48 h内ECG及6个月内CVE发生率,并采用Logistic回归分析ECG异常和CVE的危险因素。结果:急性岛叶梗死病因以动脉粥样硬化为主,占71.8%,其NIHSS评分显著高于对照组(P<0.01)。左侧岛叶梗死患者窦性心动过缓(P<0.01)和心脏猝死(P<0.05)的发生率较对照组明显增高;右侧岛叶梗死后房颤的发生率有上升趋势(P=0.079)。随着岛叶梗死范围的扩大,梗死后窦性心动过缓(P<0.01)、新发房颤(P<0.05)和心脏猝死(P<0.05)的发生率随之显著升高。Logistic回归分析发现,大面积岛叶梗死明显增加梗死后窦性心动过缓的发生(OR=4.660,95%CI:1.646~13.195;P=0.004)。结论:急性岛叶梗死易引起ECG异常改变和心脏猝死,左侧岛叶梗死增加窦性心动过缓的发生,提示心脏的副交感神经活性增强;岛叶梗死的受累范围越大,其心脏植物神经功能障碍发生越多,需引起临床注意。

Objective: To investigate the influence of location and size of acute insular infarct on stroke-related electrocardiogram(ECG) changes and cardiovascular events.Methods: Ninety-nine cases admitted to hospital from October 2007 to June 2009,who were diagnosed as acute middle cerebral artery territory infarct within 48 h after onset and without the history of cardiac diseases,were included in the study.The patients were further divided into three groups: major insular infarct,minor insular infarct and control group,according to the infarct size on MRI diffusion-weighted image.The clinical data,ECG changes and cardiovascular events were compared between left and right insular infarct.Logistic regression was applied to determine the independent risk factors of ECG changes and cardiovascular events. Results: Large artery atherosclerosis was the main cause of acute insular infarct(71.8%),which was associated with higher NIHSS score compared to the control group(P<0.01).Comparing the left and right insular infarct,the frequencies of sinus bradycardia and sudden cardiac death were significantly higher in left insular infarct(P<0.01 and P<0.05),while there was a trend that the frequency of atrial fibrillation was higher in right insular infarct(P=0.079).With the larger size of insular infarct,the frequency of sinus bradycardia,new atrial fibrillation and sudden cardiac death(P<0.01,P<0.05 and P<0.05,respectively)became much higher.Logistic regression analysis showed that major insular infarct was related to the higher frequency of sinus bradycardia(OR=4.660,95%CI:1.646～13.195;P=0.004).Conclusions: Acute insular infarct is associated with the stroke-related ECG changes and sudden cardiac death.Left insular infarct is related to sinus bradycardia,possibly due to the enhanced parasympathetic tone.It deserves clinical attention that the incidence of cardiac autonomic disturbance becomes higher with the enlarged insular infarct size.