T波电交替对急性心肌梗死患者恶性心律失常的预测价值

Value of T-wave alternans in predicting malignant arrhythmia after acute myocardial infarction

目的探讨时域法微伏级T波电交替（MTWA）对急性心肌梗死（AMI）患者住院期间恶性心律失常的预测价值。方法 105例AMI患者（AMI组）,其中男性77例,女性28例;年龄32~84岁,平均年龄62岁。38例冠状动脉正常者（对照组）,其中男性25例,女性13例;年龄41~79岁,平均年龄59岁。分析2组24h动态心电图检查资料。依据住院期间有无室性心动过速或心室纤颤,将105例AMI患者分为恶性心律失常组（34例）和非恶性心律失常组（71例）。结果 AMI组MTWA高于对照组（P〈0.05）。AMI患者中恶性心律失常组与非恶性心律失常组MTWA差异具有显著统计学意义（P〈0.01）。以MTWA≥25μV为截点,预测AMI患者发生恶性心律失常的灵敏度、特异度、阳性预测值、阴性预测值分别为50.00%、80.28%、54.84%、77.03%。结论时域法测量MTWA对AMI患者住院期间恶性心律失常的发生有预测价值,可用于AMI患者的危险分层。

Objective To investigate the value of microvolt T-wave alternans（MTWA） based on dynamic electrocardiogram in predicting malignant arrhythmia in patients with acute myocardial infarction（AMI）.Methods A total of 105 AMI patients（male 77,female 28,aged 32-84 years old,mean age 62 years old） and 38 normal controls（male 25,female 13,aged 41-79 years old,mean age 59 years old） were enrolled.The results of 24-hour ambulatory ECG data in all of them were analyzed.The 105 AMI patients were divided into malignant arrhythmia group（34 cases） and non-malignant arrhythmia group（71 cases） according to whether they had experienced an episode of ventricular tachycardia（VT） or ventricular fibrillation（VF） during hospitalization.Results The MTWA in AMI group was higher than that in the control group（P 0.05）,and MTWA showed significant difference（P 0.01） between malignant arrhythmia group and non-malignant arrhythmia group.When MTWA ≥ 25 μV was employed to predict VT/VF in AMI patients,the sensitivity,specificity,positive predictive value,and negative predictive value was 50.00 %,80.28 %,54.84 %,and 77.03 %,respectively.Conclusion It is demonstrated that MTWA of AMI patients detected by time-domain analysis could play a predictive role in malignant arrhythmia during hospitalization,and could be used to identify high risk AMI patients.