动态心电图心率变异性及QT离散度对急性心肌梗死心室颤动的预测价值

The value of QT dispersion and heart rate variability in predicting early ventricular fibrillation after acute myocardial infarction

目的探讨基于动态心电图记录的三导联QT离散度及心率变异性对急性心肌梗死住院期间心室颤动的预测价值.方法 1998～2000年,对北京朝阳医院的72例急性心肌梗死患者据住院期间有无心室颤动分为室颤组(12例)和非室颤组(60例).均于发病6 h内进行动态心电图监测.采用动态心电分析仪,计算心率变异性指标(SDNN、HF、LF/HF)及QT离散度指标(QTd、QTpd).结果 (1)急性心肌梗死患者非室颤组和室颤组的SDNN、HF、LF/HF差异均有显著性(P<0.05),QTd和QTpd没有显著性差异(P值分别为0.828和0.817).SDNN和LF/HF预测室颤有较好的敏感性、特异性及预测值.结论心率变异性的时域指标SDNN及频域指标LF/HF能用于评价急性心肌梗死患者的预后,而QT离散度、QTp离散度对住院期间室颤未发现有预测价值,需进一步探讨.

Objective The aim of this study was to evaluate the value of QT dispersion and heart rate variability in predicting early ventricular fibrillation during hospitalization after acute myocardial infarction. Methods Seventy - two patients underwent 24 - hour Holter monitoring within 6 hours after onset of acute myocardial infarction. They were divided into 2 groups, VF group （12 cases） and Non- VF group （60 cases）, based on whether they had experienced an episode of ventricular fibrillation during their hospitalization. Index of QT dispersion and heart rate variability were calculated on the basis of 24 hours Holter recording. Results The HRV indexes showed significant difference （ respectively, P 〈0.05） between two groups. SDNN≤50ms and LF/HF≤1. 2 had good sensitivity, specificity, positive predictive value and negative predictive value in predicting ventricular fibrillation. QTd and QTpd showed no significant difference （respectively, P = 0.828 and 0.817） between VF and non - VF group. Conclusion SDNN and LF/HF can predict ventricular fibrillation during hospitalization after acute myocardial infarction. The value of QTd and QTpd in predicting ventricular fibrillation remains uncertain.