QT离散度对心肌梗死患者预后的临床评价

Clinical assessment of QT dispersion for prediction of old myocardial infarction

目的 探讨QT离散度 (QTd)对陈旧性心肌梗死患者临床预后的价值。方法 139例陈旧性心肌梗死 (OMI)患者记录静态 12导联同步心电图 ,计算QTd ,平均随访 (2 5 .2± 10 .0 )个月。结果 随访期间共发生临床事件 43例 ,发生率为 31% ,其中心原性死亡 11例 ,再次心肌梗死 10例 ,严重室性心律失常 13例 ,心力衰竭 9例。所有患者按QTd≤ 70ms和 >70ms分为两组 ,经Kaplan Meier曲线分析 ,QTd >70ms组临床事件发生率明显高于QTd≤ 70ms组 (P <0 .0 1)。利用COX回归单因素分析显示 ,以临床事件为终点时 ,比例风险比 (HR)为 2 .41(P <0 .0 1) ,多因素COX回归分析调整年龄、冠状动脉病变支数、左室射血分数 (LVEF)等因素后比例风险比 (HR)为 2 .5 6 (P <0 .0 1)。结论 QTd在多个潜在的不利于OMI患者的预后因素中 。

Objective To assess the value of QT dispersion (QTd) for prediction of old myocardial infarction. Methods QTd was measured in resting 12 lead ECG in 139 patients. The average follow up period was (25.2±10) months. Results At the end of follow up duration, 43 patients reached one of the prospectively defined study endpoints (death from cardiac causes, reinfarction , ventricular arrhythmias or congestive heart failure). All of the patients were divided into QTd≤70 ms and QTd>70 ms groups QTd>70 ms group had more clinical events than QTd ≤70 ms group by Kaplan Meier analysis ( P <0.01). With clinical events as endpoint, proportional hazards rate (HR) was 2.41 in univariate Cox analyses ( P <0.01). After controlling for risk factors, HR was 2.56 by multivariate Cox regression ( P <0.01). Conclusion QTd is an important predictor of clinical event in old myocardial infarction patients.