T波电交替及心率变异性对恶性心律失常的预测价值

Value of T wave alternans and heart rate variability in predicting malignant arrhythmia

目的：分析急性心肌梗死（AMI）患者微伏级T波电交替（MTWA）以及心率变异性（HRV）指标,探讨其对AMI患者住院期间恶性心律失常的预测价值。方法：117例AMI患者（AMI组）,男性86例,女性31例;年龄32~84岁,平均年龄（61±11）岁。分析其24 h动态心电图检查资料。依据住院期间有无室速或室颤,将117例AMI患者分为恶性心律失常组（37例）和非恶性心律失常组（80例）。结果：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,MTWA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%。MTWA以及SDNN（SDANN）联合预测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20.59%（20.59%）、94.37%（95.77%）、63.64%（70.00%）、71.28%（71.58%）。结论：MTWA及HRV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） and heart rate variability（HRV） in predicting malignant arrhythmia during hospitalization in patients with acute myocardial infarction（AMI）.Methods： A total of 117 AMI patients [male 86,female 31,aged 32～84 years old,mean aged（61±11） years old] were enrolled.The results of 24 hour ambulatory ECG data in117 AMI patients were analysed.117 AMI patients were divided into malignant arrhythmia group（37 cases） and non-malignant arrhythmia group（80 cases） basing on weather they had experienced an episode of ventricular tachycardia（VT） or ventricular fibrillation（VF） during their hospitalization.Results： MTWA showed significant difference（P 0.01） between malignant arrhythmia and non-malignant arrhythmia group.MTWA was positive（MTWA≥25 μV）,the sensitivity for diagnosis of malignant arrhythmia in AMI patients was 50.00%,specificity was 80.28%,positive predictive value was 54.84%,and negative predictive value was 77.03%.MTWA and SDNN（SDANN） were positive,the sensitivity was 20.59%（20.59%）,specificity was 94.37%（95.77%）,positive predictive value was 63.64%（70.00%）,and negative predictive value was 71.28%（71.58%）.Conclusion： MTWA and HRV of AMI patients could play the predictive role in malignant arrhythmia during hospitalization,and could be used to identify high risk patients from AMI patients.