多项指标联合检测对急性心肌梗死患者心源性死亡的预测价值

Value of multiple-index join detection in predicting cardiac death in patients with acute myocardial infarction

目的:研究多项指标联合检测对急性心肌梗死(Acute myocardial infarction,AMI)患者心源性死亡的预测价值。方法:362例发病≤3周的急性心肌梗死后窦性心律的患者入选,用超声诊断仪获取心率震荡(heart rate tubrulence,HRT)的震荡起始(TO)与震荡斜率(TS)指标、心率变异性(HRV)的时域指标(SDNN)与心率变异三角指数(HRVTI),常规超声心动图指标:左房舒张末期前后径(LAED)、左室舒张末期前后径(LVED)、左室射血分数(LVEF)和短轴缩短率(LVFS)等指标,确定阳性界定值,以心源性死亡为标准分为死亡组与幸存组,根据敏感度、特异度比较单独指标及联合指标对心源性死亡的预测价值。结果:两组间TS、TO、LVEF、LVED、HRVTI的阳性率差异有显著性(P<0.05),SDNN、LAED和LVFS的阳性率差异无显著性(P均>0.05);HRT(TO与TS)、HRV(SDNN与HRVTI)及常规超声心动图(LAED、LVED、LVEF和LVFS)等指标的单类和两类联合敏感性和特异性的百分比分别为79.12、58.21,71.74、66.17,68.36、34.30,72.58、51.26,55.84、51.04,63.11、63.27,67.75、68.11 64.93、42.29,89.45、72.11,83.51、81.08,79.94、82.12,三类多项指标联合检测的敏感性和特异性为96.83%和85.20%,高于单项或两项对急性心梗患者心源性死亡的预测敏感性和特异性。结论:HRT(TO与TS)、HRV(SDNN与HRVTI)及LAED、LVED、LVEF和LVFS等多项指标联合检测对心源性死亡的预测价值高于HRT、HRV和常规超声心动图指标或两类指标联合的预测价值。

Objective： To investigate the predlctlve value ot multlple-mdex Join detectlon in p ting cardiac death for patients with acute myocardial in{arction. Methods= A total of 362 patients that rienced acute myocardial infarction within 3 weeks were enrolled. Heart rate turbulence （HRT） incl turbulence onset（TO） and turbulence slope （TS）, heart rate variability（HRV）including time domain xes （SDNN）, heart rate variability triangular index were collected at the same time. Eehocardiog redlc- expe- [uding inde- raphy was used for the assessment of parameters included end-diastolic diameter of left atrial（LAED）, end-dias- tolic diameter of left ventricle （LVED）, the left ventricular ejection fraction （LVEF） and the left ventricu- lar fractional shortening（LVFS）. Survival group and death group were divided according to occurrence of cardiac death. Sensitivity and specificity was used to compare the value of single index and combined multi- ple-index for predicting cardiac death. Results： There were significant difference in positive rates of TS, TO, LVEF, LVED, HRVTI between the two groups （P%0.05）. But positive rates of SDNN, LAED and LVFS were not significantly different （P%0.05）. Percentage of sensitivity and specificity in HRT（TO and TS） .HRV（SDNN and HRVTI）and echocardiographic values（LAED.LVED. LVEF and LVFS）of single and combined detection were 79.12 %, 58.21%, 71.74 %, 66.17 %, 68.36 %, 34.30 % , 72.58 %, 51.26 % , 55.84% .51. 04%, 63. 11%, 63. 27%, 67. 75%. 68. 11%, 64. 93%.42. 29%, 89. 45%,72. I1%, 83.51%.81.08%, 79.94%.82.12%. Sensitivity and specificity of joint detection in HRT were 96.83% and 85.20%, which were significant higher than single detection or combined detection of two indexes. Conclusions： The value of multiple-index join detection in predicting cardiac death in patients with acute myocardial infarction were higher than detection of a single index or combined detection of two indexes.