心率减速力与心率变异性对急性心肌梗死患者心脏不良事件的预测价值

Value of DC and DRs in prediction of cardiovascular events in acute myocardial infarction patients

目的探讨心率减速力（DC）、连续心率减速力（DRs）及心率变异性对急性心肌梗死患者心脏不良事件的预测价值。方法选取2012年8月至2013年8月在解放军总医院心血管内科住院明确诊断为急性心肌梗死且心电图为窦性心律的患者166例并进行随访。分别以心率减速力与心率变异性相关指标作为检验变量，以患者随访期间心源性死亡和心脏不良事件作为状态变量，绘制ROC曲线比较各指标的预警能力，比较其评估价值。结果共随访（20．5±2．8）个月，随访期间患者发生心源性死亡13例，与未发生心源性死亡组比较，心率减速力及心率变异性中NN间期标准差（SDNN-24）差异有统计学意义（P〈0．05），其中DC的ROC曲线下面积为0．852、DR4的ROC曲线下面积为0．874、DR8的ROC曲线下面积为0．804，均大于SDNN．24的ROC曲线下面积0．727。随访期间患者发生心脏不良事件组与未发生事件组比较，DC、DR2、DR4及心率变异性中相邻NN间期差值的方根（RMSSD）差异有统计学意义（P〈0．05），其中DC的ROC曲线下面积为0．709略大于RMSSD的ROC曲线下面积为0．704。结论DC及DRs危险分层对急性心肌梗死猝死高危人群筛选与预警有较强的实用价值。

Objective To investigate the value of deceleration capacity of rate （DC） and heart rate deceleration runs （DRs） in predicting cardiovascular events in patient with acute myocardial infarction （AMI）. Methods This study included 166 patients with AMI, who underwent ECG with sinus rhythm. These patients were followed-up for major adverse cardiac events （ MACE ）. The receiver operating characteristic curve （ROC） was drawn to determine the best values for estimating the MACE. Results The mean follow-up time was （ 20. 5 ＋- 2. 8 ） months, with 13 cases of cardiac death. There was statistically significant difference of DC, DRs and standard diviation of NN intervals （SDNN-24） between the death group and survival group. The area under the curve （ AUC ） of DC, DR4 and DR8 were larger than SDNN-24 （0. 874,0. 804 vs 0. 727 ）. The values of DC, DR2, DR4 and root mean square of the successive differences （RMSSD） in the group of patients who underwent cardiac adverse events were smaller than the group of patients who didn＇t, and the AUC of DC was slightly higher than that of RMSSD. Conclusion DC and DRs have important predictive value for cardiac death and MACE and can screen high-risk patients in patients with AMI.