急性心肌梗死患者T波电交替及窦性心率震荡的特征及临床意义

The clinical manifestation and characteristic of ambulatory ecg-based t-wave alternans and heart rate turbulence in patients with acute myocardial infarction

目的研究心肌梗死及心肌梗死合并糖尿病患者T波电交替(TWA)和窦性心率震荡(HRT)的特征及其临床意义。方法选取149例患者,其中心肌梗死(MI)57例,心肌梗死合并糖尿病(MI+DM)52例,对照组40例。给予动态心电图检查,应用时域分析法和渐量修正技术分析TWA值,以及HRT的两个参数:震荡初始(TO)、震荡斜率(TS)。分析:1三组患者TWA、TO及TS均值的比较;TWA阳性率的比较;2心肌梗死患者复合心脏事件(室速/室颤、心脏性死亡)的发生率。结果 1MI组和MI+DM组患者TWA均值及TWA的阳性率明显高于对照组(P<0.01),MI+DM组患者TWA的阳性率高于MI组,但TWA均值差异无统计学意义;2MI+DM组室速/室颤发生率高于MI组(P<0.05),MI+DM组心脏性死亡患者2例;3心肌梗死患者的震荡初始(TO)较对照组增加(P<0.05),而震荡斜率(TS)则减低(P<0.01)。结论心肌梗死患者TWA值增加,HRT的两个参数-TS减弱而TO增加。TWA和HRT可能为评价心肌梗死患者发生恶性心律失常及心脏性猝死的有用指标。

Objective To explored the characteristic and clinical manifestation in patients with ischemic heart diseases according to T-wave alternans( TWA) using modified moving average( MMA) method and heart rate turbulence( HRT). Methods A analysis of 149 patients who underwent MMA-based TWA and HRT divided into 3 groups:group-C of 40 controls,group-MI of 57 patients with myocardial infarction,52 patients with MI with diabetes( group-MI +DM). The TWA was calculated automatically using time-domain modified moving average method. Group-MI was divided into two subgroups: HRT abnormal subgroup and HRT normal subgroup and the accidence of cardiac events of inhospitalization was observed in the two subgroups. Result The TWA value was differ significantly between MI and controls( P < 0. 001). Among MI with diabetes,the accidence of ventricular tachyarrhythmia is higher than MI. Impaired HRT were observed most frequently in group- MI( P < 0. 05),especially the decrease of the HRT onset slope( TS)( P < 0.05). Conclusion T-wave alternans is elevated in patients following myocardial infarction. Weaken HRT,increased To and decreased TS were observed in myocardial infarction patients. TWA and HRT may be independent predictors of cardiac and arrhythmic death in myocardial infarction patients.