心率变异性与运动试验对心肌梗死预后评估的价值

Value of Heart Rate Variability and Exercise Test in Evaluating Prognosis of Myocardial Infarction

目的：探讨心率变异性（ HRV）及平板运动试验（ TET）评估心肌梗死患者心功能及预后的价值。方法心肌梗死患者60例，梗死后1～3周行24 h动态心电图检查，分析HRV指标，根据全部窦性心率间期的标准差（ SDNN）评判患者危险度；梗死后3～6周行 TET，并进行危险分层。结果运动试验阳性，运动量≤4 Met，心功能Ⅲ级9例；运动试验可疑阳性，运动量≤5 Met，心功能Ⅱ～Ⅲ级14例；运动试验阴性，运动量≥6 Met，心功能Ⅱ级以下37例。按SDNN标准属高危组10例，中危组22例，低危组28例。随访1年，高、中危组发生恶性心律失常6例，再发心肌梗死2例，死亡2例。低危组无以上心脏事件发生。结论 HRV联合TET对心肌梗死患者进行预后及心功能的评估有重要临床价值。

Objective To investigate the clinical value of heart rate variability （ HRV） and treadmill exercise test（TET） in the assessment of heart function and prognosis of patients with myocadial infarction （MI）.Methods Sixty patients with myocardial infarction received 24-hours dynamic electrocardiogram 1 -3 weeks after the onset of thedisease.HRV index was analyzed, and the risks were assessed according to standard diviation of NN intervals（SDNN）.TET was performed 3 -6 weeks after the onset of the disease,and the risk stratification in patients wasconducted.Results The result of TET showed 9 cases positive,with the exercise consumption no more than 4 Met andheart function of grade Ⅲ,14 cases suspected positive,with the exercise consumption no more than 5 Met and heartfunctions of grade Ⅱ -Ⅲ,and 37 cases negative,with the exercise consumption no less than 6 Met and heart functionlower than grade Ⅱ.According to the SDNN standard,10 cases,22 cases and 28 cases were stratificated into high-riskgroup,medium-risk group and low-risk group respectively.After the 1-year follow-up,there were 6 cases of malignantventricular arrhythmia,2 cases died for recurrent MI and 2 cases of death in the high-and medium-risk groups.Nocardiac events mentioned above occurred in the low -risk group.Conclusion The combination of HRV and TET isvaluable in evaluating the prognosis and heart function of patients with MI .