115例心率减速能力对急性心肌梗死患者短期预后的预测价值

The influence of deceleration capacity of heart rate and heart rate deceleration runs on evaluating short-term prognosis of 115 patients with acute myocardial infarction

目的探讨急性心肌梗死(AMI)患者心率减速能力的变化及其对患者短期预后的影响。方法选择115例发病7d以内确诊AMI患者(AMI组)和50例无心肌梗死来院健康体检者作为对照(对照组)。所有患者发病7～14d内完善24h动态心电图检查,通过心率减速力(DC)和连续心率减速力(DRs)检测将两组患者心率减速能力,按照从高到低分为低风险、中风险、高风险亚组,同时用超声心动图检测左心室射血分数(LVEF),比较两组在心率减速能力方面的差异;对AMI患者平均随访(9.2±1.7)个月,观察随访期间主要不良心血管事件(MACE)发生情况,应用Logistic回归筛选分析MACE发生的危险因素。结果与对照组比较,AMI组风险分层较高,心率减速能力较弱(P<0.05)。MACE事件组与非MACE事件组比较其心率减速能力高风险比例显著增加(P=0.005),低风险比例显著减少(P=0.039)。Logistic回归分析显示LVEF值、心率减速能力高风险、年龄和有无经皮冠脉介入治疗(PCI)是本组AMI患者短期随访期间发生MACE事件的独立危险因素。相关系数r分别为0.33、0.30、0.23、0.18,相对危险度(OR)分别为4.83、4.28、2.22、1.58,心率减速能力相关性仅稍弱于LVEF,当LVEF、年龄进入回归方程时,决定系数r2为0.528,增加心率减速能力高风险进入回归方程后,决定系数r2显著增加至0.635。结论 AMI患者的心率减速能力减弱,LVEF值、心率减速能力显著减弱、年龄和有无PCI是AMI患者短期发生MACE事件的独立危险因素,DC和DRs检测在评价患者预后中稍弱于LVEF,但如果联合运用能更好地预测AMI患者短期预后。

Objective To investigate the effects of altered deceleration capacity of heart rate （DC） and heart rate deceleration runs（DRs） on the short-term prognosis of patients with acute myocardial infarction （AMI） .Methods 115 patients confirmed with AMI within 7 days as AMI group ,50 persons without MI were selected as control group .The deceleration capacity of heart rate and heart rate deceleration runs were detected by the 24 hours Holter within 7 to 14 after onset of AMI ,all the patients were divided in-to high risk group ,medium risk group and low risk group through the Holter results .Left ventricular ejection fraction （LVEF） was evaluated by echocardiography .Compare the risk of the AMI group with the control group .Meanwhile the AMI patients were fol-lowed up for mean（9 .2 ± 1 .7）months .Observe the presence of major adverse cardiovascular events （MACE） .All AMI patients were classified into MACE and non-MACE groups according to the presence of MACE .Analysis the risk factors of MACE .Results AMI group had a significant increase risk but decrease in deceleration capacity of heart rate （P〈0 .05） as compared with the control group .In MACE group ,the rate of high risk was significant increasing（P=0 .005） ,but the rate of low risk was significant decrea-sing（P=0 .039） .The Logistic regression analysis showed that LVEF ,high risk group ,age and percutaneous transluminal coronary intervention（PCI） were independent risk factors on presence of MACE .Correlation r was 0 .33 ,0 .30 ,0 .23 ,0 .18 respectively ,and odds ratio was 4 .83 ,4 .28 ,2 .22 ,1 .58 respectively ,the correlation with deceleration capacity of heart rate was a little weaker than LVEF .The coefficient of determination r2 was 0 .528 when the LVEF and ages went into regression ,whereas that was 0 .635 when the LVEF ,high risk group and age went into regression together .Conclusion Capacity of heart rate decelerate was significantly weakened in AMI patients .LVEF ,the significantly decreased deceleration capacity of heart rate ,age and PCI were independent risk factors on presence of short-term MACE in AMI patients .The prognostic value of the DC and DRs was a little weaker than the LVEF .The better predictive value was obtained if the LVEF ,the significantly decreased deceleration capacity of heart rate ,age were combined .