24 h动态心电图参数在恶性室性心律失常患者危险分层及预后中的预测价值

Risk Stratification and Prognostic Value of 24 Hours Holter Electrocardiogram Parameters in Patients with Malignant Ventricular Arrhythmias

目的探讨24 h动态心电图参数在恶性室性心律失常(MVA)患者危险分层及预测预后价值。方法选取2021年1月至2023年1月河南省第二人民医院收治的89例MVA患者作为研究组,按照1∶1比例纳入同期89例健康体检者作为对照组。统计两组24 h动态心电图参数,Spearman分析24 h动态心电图参数与危险分层关系,另将研究组根据胺碘酮治疗4周后生存情况分为存活亚组和死亡亚组,比较两组24 h动态心电图参数、12导联同步心电图参数,绘制受试者工作特征曲线(ROC)及曲线下面积(AUC)分析24 h动态心电图预测MVA预后价值。结果(1)研究组24 h正常心房开始除极至心室开始除极时间间期标准差(SDNN)、24 h连续5 min正常R-R间期标准差(SDANN)、PNN50为相邻N-N间期超过50 ms的百分比(PNN50)、24 h-QTV为24 h QT间期变异性(24 h-QTV)均低于对照组,且研究组Ⅴ级<ⅣB级<ⅣA级(P<0.05);(2)研究组患者SDNN、SDANN、PNN50、24 h-QTV与危险分层呈负相关(P<0.05);(3)研究组死亡亚组和存活亚组治疗2周后SDNN、SDANN、PNN50、24 h-QTV、T波峰末间期(Tp-Te)、T波峰末间期/QT间期(Tp-Te/QT)、校正后T波峰末间期(Tp-Tec)比较差异有统计学意义(P<0.05);(4)治疗2周后SDNN、SDANN、PNN50、24 h-QTV联合预测MVA预后价值优于Tp-Te、Tp-Tec、TP-Te/QT联合预测价值。结论MVA患者SDNN、SDANN、PNN50、24 h-QTV与危险分层呈负相关,联合检测有助于提高预后预测价值,指导临床诊治,促进疾病良好转归。

Objective To investigate the risk stratification and prognostic value of 24 hours holter electrocardiogram parameters in patients with malignant ventricular arrhythmia(MVA).Methods A total of 89 MVA patients admitted to Henan Second Provincial People’s Hospital from January 2021 to January 2023 were selected as the study group,and 89 healthy subjects in the same period were included as the control group in a 1∶1 ratio.The 24 hours holter electrocardiogram parameters of the two groups were analyzed by Spearman and the relationship between the 24 hours holter electrocardiogram parameters and risk stratification was analyzed.The study group was divided into survival subgroup and death subgroup according to the survival status after 4 weeks of amiodarone treatment.The 24 hours holter electrocardiogram parameters and 12-lead synchronous electrocardiogram parameters of the two groups were compared.Receiver operating characteristic(ROC)curve and area under curve(AUC)were plotted to analyze the prognostic value of 24 hours holter electrocardiogram in predicting MVA.Results(1)Standard deviation of R-R interval within 24 hours(SDNN),mean standard deviation of R-R interval per 5 min segment within 24 hours(SDANN),composition ratio of R-R interval difference between adjacent normal cardiac cycles≥50 ms(PNN50),24 hours QT interval variability(24 h-QTV)in the study group were lower than those in the control group,and gradeⅤ<ⅣB<ⅣA(P<0.05).(2)SDNN,SDANN,PNN50,24 h-QTV were negatively correlated with risk stratification in study group(P<0.05).(3)There were significant differences in SDNN,SDANN,PNN50,24 h-QTV,T peak-T end(Tp-Te),T peak-T end/QT interval(Tp-Te/QT),corrected T peak-T end(Tp-Tec)between the death subgroup and the survival subgroup after 2 weeks of treatment(P<0.05).(4)After 2 weeks of treatment,SDNN,SDANN,PNN50 and 24 h-QTV combined prognostic value of MVA was better than that of Tp-Te,Tp-Tec and TP-Te/QT combined prognostic value.Conclusion SDNN,SDANN,PNN50,24 h-QTV in MVA patients are negatively correlated with risk stratification.Combined detection is helpful to improve prognostic value,guide clinical diagnosis and treatment,and promote good outcome of the disease.