老年急性非ST段抬高型心肌梗死患者心率减速力与室性心律失常的相关性研究

Correlation between deceleration capacity of heart rate and ventricular arrhythmias in elderly patients with acute NSTEMI

目的探讨心率减速力(DC)与心肌梗死后室性心律失常的相关性。方法选取2019年1月至2021年6月在天津市第三中心医院心脏中心诊断为急性非ST段抬高型心肌梗死且心电图为窦性心律的患者101例为试验组,健康体检者102例为对照组,比较2组的室性期前收缩总频数、室性期前收缩指数(PI)、DC;试验组按照美国Lown级标准分为0~2级组63例和3~5级组38例,使用Pearson相关性分析试验组DC值与PI的相关性。结果试验组室性期前收缩总频数明显高于对照组,PI、DC明显低于对照组(P<0.05,P<0.01)。0~2级组PI、DC明显高于3~5级组(P<0.01)。在试验组中,DC与PI呈显著正相关(r=0.730,P<0.01),与室性期前收缩总频数无明显相关性(r=-0.545,P>0.05)。DC预测心肌梗死后恶性室性心律失常发生的ROC曲线下面积为0.894(95%CI:0.823~0.964,P<0.01)。结论DC与心肌梗死后恶性室性心律失常(室性心动过速、心室颤动和扑动)密切相关,有望联合PI成为心肌梗死后恶性室性心律失常的新型预警指标。

Objective To investigate the correlation between deceleration capacity of heart rate(DC)and ventricular arrhythmias after myocardial infarction.Methods A total of 101 patients diagnosed with acute NSTEMI and sinus rhythm on ECG from January 2019 to June 2021 at the Heart Center of our hospital were enrolled and subjected as the test group,and another 102 healthy participants served as the control group.The total frequency of premature ventricular contraction,PI and DC values were compared between the two groups.According to Lown classification,the test group was divided into 63 cases of Class 0-2 and 38 cases of Class 3-5.Pearson correlation analysis was used to analyze the correlation of DC value with PI value.Results The total frequency of premature ventricular contraction was significantly higher,while the PI and DC values were obviously lower in the test group than the control group(P<0.05,P<0.01).And the PI and DC values were notably higher in the Class 0-2 group than in the Class 3-5 group(P<0.01).In the test group,there was a positive correlation between DC and PI(r=0.730,P<0.01)and no significant correlation between DC and the total frequency of premature ventricular contractions(r=-0.545,P>0.05).The area under the ROC curve for DC predicting the occurrence of malignant ventricular arrhythmias after myocardial infarction was 0.894(95%CI:0.823-0.964,P<0.01).Conclusion DC is closely associated with post-infarction malignant arrhythmias(ventricular tachycardia,ventricular fibrillation and flutter)and is expected to be a novel early warning indicator of post-infarction malignant arrhythmias in combination with PI.