QT间期动态性对急性心肌梗死患者心律失常事件的预测价值

Predictive Value of QT Interval Dynamicity for Arrhythmic Event in Patient with Acute Myocardial Infarction

目的研究QT间期频率依赖性在心肌梗死(AMI)患者心律失常事件预测中的作用。方法选取120例冠心病心肌梗死患者。询问病史并行心脏超声、心电图和动态心电图检查。检测QT间期离散度(QTd)、QT/RR相关直线的斜率、心率变异性(SDNN)、左室舒张末期内径(LVEDD)、左室射血分数(LVEF)、24 h室性早搏(VPB)和非持续性室性心动过速(NSVT)的次数。随访AMI患者6个月,心律失常事件为持续性室速(VT),心室颤动(VF)或心脏性猝死。结果 AMI心律失常事件组和无心律失常事件组比较,QTd、QTe/RR(QTe为Q波起始至T波终点的间期)和QTp/RR(QTp为Q波起始至T波顶点的间期)斜率、VPB、NSVT、LVEDD、QTe/RR和QTp/RR斜率、LVEF、SDNN的差异有统计学意义。结论 QT间期频率依赖性对冠心病患者心律失常事件有较高的预测价值,并可进一步提高NSVT和LVEF的预测价值。

Objective To study the predictive value of QT interval dynamicity for arrhythmic event in patient with acute myocardial infarction（AMI）.Methods One hundred and twenty patients with AMI（AMI group） were enrolled in this study.Investigations included history collection,clinical examination,echocardiography,electrocardiogram and 24-hour ambulatory electrocardiogram.Following indexes were determined： left ventricle end diastolic dimension（LVEDD）,left ventricle ejection fraction（LVEF）,QT dispersion（QTd）,SDNN,the slope of QT/RR plots of the linear regression,ventricular premature beats（VPB） and non-sustained ventricular tachycardia（NSVT）.Primary end point for patients with AMI was arrhythmic events including ventricular tachycardia（VT）,ventricular fibrillation（VF） and cardiac death.Results There were statistically significant differences in LVEDD,LVEF,QTd,SDNN,VPB/24h,NSVT/24h,QTe/RR slope and QTp/RR slope between arrhythmic events group and non-arrhythmic events group.Conclusions QT/RR slope is a risk factor for arrhythmic events of AMI patients,and moreover,it is a useful predictor for cardiovascular event in AMI patients either independently or combined with NSVT or LVEF.