窦性心率震荡现象对急性心肌梗死后患者死亡预测价值的临床研究

Clinical research of heart rate turbulence on predictive value in patients with acute myocardial infarction

目的评价窦性心率震荡现象对急性心肌梗死后患者死亡的预测价值。方法急性心肌梗死稳定期患者125例。于心肌梗死后6～21天行24小时Holter检查。将Holter文件在HRT!View V0.60-1程序下处理,取得心率震荡参数震荡起始(TO)及震荡斜率(TS)值。同时获取心率变异SDNN及超声心动图检测的左室射血分数、左室舒张末期直径的参数。对患者进行随访,终点事件是患者心原性死亡。根据随访结果将患者分成生存组及死亡组。分析两组各变量对死亡是否有预测意义,评判各自预测能力。结果两组平均随访(225.4±99.8)天,14人死亡,111人存活。单变量回归分析显示TS是极强的风险预测因子(RR=11.46,P<0.01),TO≥0的预测价值较低(RR=2.76,P>0.05),TO与TS均异常对死亡具有最强的预测意义(RR=26.70,P<0.01)。在多变量回归分析中,TS≤2.5ms/RR及左室舒张末期直径≥5.6cm是仅有的2个独立风险预测变量,RR分别为9.49(P<0.01)和3.64(P<0.05)。结论室性早搏后窦性心率震荡现象的减弱或消失是急性心肌梗死后患者死亡的独立预测指标。

Objective To assess the predictive value of heart rate turbulence （HRT） in patients with acute myocardial infarction. Methods One hundred and twenty-five patients with acute myocardial infarction were enrolled in this study. During the period from 6 to 21 days after onset of acute myocardial infarction, they were undergone 24-hour Holter recordings to collect the mean RR interval and heart rate variability （HRV） SDNN. The Holter files were processed with software of “ HRT! View V0. 60-1 ” to obtain the value of Turbulence Onset （TO） and Turbulence Slope （TS） and the value of “ heart rate variability （HRV） SDNN”. LVEF and EDD were measured by Ultrasonic Cardiography. Endpoint of followup was cardiac death. According to the results, patients were divided into two groups （the “survivors” and the “ nonsurvivors”） . The predictive value for high-risk patients with acute myocardial infarction was assessed by variables between the two groups. Results In the period of follow-up （ mean 225.4 ± 99. 8 days）, 14 patients died and 111 patients survived. In the univariate Cox regression analysis, “TS” was a strong univariate predictor of mortality （hazard ratio 11.46, P 〈 0. 01 ）;“TO” was a relatively weak predictor and the hazard ratio was 2. 76（ P 〉 0. 05 ）. Combination of abnormal TO and abnormal TS was the strongest mortality predictor （ hazard ratio 26. 70, P 〈 0. 01 ） ; in the multivariate Cox regression analysis, TS≤2. 5 ms/RR and EDD≥5.6 cm were the independent predictors of mortality with hazard ratios 9. 49（ P 〈 0. 01 ） and 3.64 （ P 〈 0. 05 ）, respectively. Conclusions The absence of the heart rate turbulence after ventricular premature beats is a very potent pest-infarction risk predictor which is independent of and stronger than other known risk predictors.